Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 04-36245 | KS |
N | 207K00000X | Allergist & Immunologist | 2013006648 | MO |
Y | 2080P0201X | Pediatric Allergist | 229803 | NY |
NPI | 1144302290 |
---|---|
Provider Name | Dr. Mamta S Reddy |
First Address | Kansas City, MO 64108 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 04/04/2013 |