Basic Information
| Provider Information | |||||||||
| NPI: | 1821257668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHANIREDDY | ||||||||
| FirstName: | KIRAN | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1289 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336011289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138447000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 409 BAYSHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138445544 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | A103967 | CA | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | A103967 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | ME136464 | FL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
ID Information
| ID | Type | State | Issuer | Description | 025040200 | 05 | FL | MEDICAID |