Healthcare Provider Details

I. General information

NPI: 1689255200
Provider Name (Legal Business Name): VENKATRAMESH REDDY MEDAPATI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 N JOSEY LN STE 206
CARROLLTON TX
75010-4631
US

IV. Provider business mailing address

4333 N JOSEY LN STE 206
CARROLLTON TX
75010-4631
US

V. Phone/Fax

Practice location:
  • Phone: 972-939-1757
  • Fax: 972-939-1682
Mailing address:
  • Phone: 972-939-1757
  • Fax: 972-939-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692175
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: