Doctor Name: | GIRIDHAR GUNTREDDI |
NPI Number: | 1467706846 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D |
License Number: | #39 |
Business Practice Address: | 123 4th St Nw Bagley, MN - 566218306 |
Business Phone Number: | 2186942384 |
Business Fax Number: | |
Mailing Address: | 709 36th St Nw, BEMIDJI |
State: | MN |
Postal Code: | 566012296 |
Phone Number: | 9735731527 |
Fax Number: | |
NPI Enumeration Date: | 11/06/2012 |
NPI Last Update Date: | 08/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | #39 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |