Healthcare Provider Details

I. General information

NPI: 1437612967
Provider Name (Legal Business Name): LALITHA PADMANABHA REDDY VEMIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD STE 33
LAS VEGAS NV
89102-1934
US

IV. Provider business mailing address

2820 W CHARLESTON BLVD STE 33
LAS VEGAS NV
89102-1934
US

V. Phone/Fax

Practice location:
  • Phone: 702-880-1558
  • Fax:
Mailing address:
  • Phone: 702-880-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number27221
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number27221
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.074538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: