Individual
RENUKA KANDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5131
(740) 446-5486
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5131
(740) 446-5486
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20268
WV
207R00000X
Internal Medicine Physician
Primary
35.074211
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006517
ANTHEM BCBS
—
01
—
000000181874
UNISON MEDICAID
OH
01
—
001714104
MOUNTAIN STATE BCBS
—
05
—
0081952000
—
WV
01
—
110166885
RR MEDICARE
—
01
—
2061512
OH MEDICAID MOLINA
OH
05
—
2061512
—
OH
01
—
310917085106
CARESOURCE MEDICAID
OH
Enumeration date
06/02/2006
Last updated
01/21/2021
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