Basic Information
| Provider Information | |||||||||
| NPI: | 1700014313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THUDI | ||||||||
| FirstName: | KAVITHA | ||||||||
| MiddleName: | REDDY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 EWING HALSELL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754837 | ||||||||
| FaxNumber: | 2105758480 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 EWING HALSELL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754837 | ||||||||
| FaxNumber: | 2105758480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 09/15/2017 | ||||||||
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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 | 207RT0003X | N3348 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | 207RI0008X | N3348 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 1023314170003 | 05 | PA | MEDICAID |