Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 27141 | IA |
NPI | 1053358226 |
---|---|
Provider Name | Suresh Katapalli Reddy |
First Address | Waterloo, IA 50704-2758 |
Second Address | Waterloo, IA 50701-9330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 16/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1281378 | (05) | IA |
41999 | WELLMARK INS PLAN (01) | IA |
421417307B2 | JOHN DEERE HEALTH INS PLN (01) | IA |
E07344 | (02) |