Basic Information
| Provider Information | |||||||||
| NPI: | 1235113259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | KARUNA | ||||||||
| MiddleName: | GHANTA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705989595 | ||||||||
| FaxNumber: | 2705989590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421342371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705989595 | ||||||||
| FaxNumber: | 2705989590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36342 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 36342 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.