Healthcare Provider Details

I. General information

NPI: 1639156961
Provider Name (Legal Business Name): MAHENDER M REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 STATE ROAD 52
HUDSON FL
34667
US

IV. Provider business mailing address

7330 STATE ROAD 52
HUDSON FL
34667-6711
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-9470
  • Fax: 727-862-6489
Mailing address:
  • Phone: 727-862-9470
  • Fax: 727-862-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0068848
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: