Healthcare Provider Details

I. General information

NPI: 1275260341
Provider Name (Legal Business Name): BHARATSIMHA REDDY TOUTIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BLVD, 130 SUITE BRG MID CITY MEDICINE CLINIC
BATON ROUGE LA
70809
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number14284554-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: