Provider Demographics
NPI:1053358226
Name:REDDY, SURESH KATAPALLI (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:KATAPALLI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:125 E TOWER PARK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9330
Practice Address - Country:US
Practice Address - Phone:319-234-5990
Practice Address - Fax:319-234-5994
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27141207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41999OtherWELLMARK INS PLAN
IA421417307B2OtherJOHN DEERE HEALTH INS PLN
IA1281378Medicaid
IA1281378Medicaid
IA421417307B2OtherJOHN DEERE HEALTH INS PLN