Individual
KISHORE REDDY RASAMALLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12895 KEYSTONE CT, ALPHARETTA, GA 30009-1526
(210) 379-8553
(910) 900-1239
Mailing address
12895 KEYSTONE CT, ALPHARETTA, GA 30009-1526
(210) 379-8553
(910) 900-1239
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
077148
GA
207R00000X
Internal Medicine Physician
M9598
TX
207R00000X
Internal Medicine Physician
MD432046
PA
208M00000X
Hospitalist Physician
M9598
TX
208M00000X
Hospitalist Physician
MD432046
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020162720001
—
PA
01
—
1747437
AETNA
PA
01
—
1988201
HIGHMARK BLUE SHIELD
PA
01
—
2864090000
PERSONAL CHOICE
PA
01
—
30046047
KEYSTONE MERCY
PA
01
—
39170
HEALTH PARTNERS
PA
Enumeration date
06/18/2007
Last updated
06/20/2024
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