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NPI Code Detail

MEDICARE: NALLU S REDDY M.D.

MEDICARE: NALLU S REDDY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianME100925FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3BH070YOTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11451XOTHERFLBC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063687556
Entity Type Code : Individual
Provider Name (Legal Business Name) : NALLU S REDDY M.D.
Provider Business Mailing Address
First Line : P.O. BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33092-2147
Country : US
Telephone Number : 239-343-2052
Fax Number : 239-343-5348
Provider Business Practice Location Address
First Line : 2776 CLEVELAND AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-5855
Country : US
Telephone Number : 239-343-2052
Fax Number : 239-343-5348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 03/30/2021

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