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General NPI Number Information
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NPI Number | 1467614610
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Entity Type | Individual
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Provider Name | PRADEEP REDDY TATAGARI
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Gender | Male
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 701 HAWK WOOD LN
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City | PROSPER
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State | TX
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Zip | 75078-2001
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Country | US
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Telephone | 270-996-7254
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Fax | 469-526-5628
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Provider Business Mailing Address
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Address Line | 701 HAWK WOOD LN
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City | PROSPER
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State | TX
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Zip | 75078-2001
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Country | US
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Telephone | 469-526-3474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 55717
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R7609
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License Number State | TX
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