MEDICARE: PRASHANT REDDY GUNDRE 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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	14272	NV

General Provider Information

NPI Number	:	1780870790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASHANT REDDY GUNDRE M.D.

Provider Business Mailing Address
First Line	:	1801 W OLYMPIC BLVD # 1270
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91199-0001
Country	:	US
Telephone Number	:	702-791-1454
Fax Number	:	702-946-1354

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0516
Country	:	US
Telephone Number	:	702-791-1454
Fax Number	:	702-946-1354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	10/11/2012

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