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General NPI Number Information
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NPI Number | 1558388579
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Entity Type | Individual
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Provider Name | VENKAT RAMANA THADAREDDY M.D
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 151 EXCHANGE BLVD STE 150
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City | HUTTO
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State | TX
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Zip | 78634-5376
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Country | US
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Telephone | 979-279-3451
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Fax | 979-279-5163
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Provider Business Mailing Address
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Address Line | 6210 E HIGHWAY 290 STE 420
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City | AUSTIN
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State | TX
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Zip | 78723-1142
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Country | US
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Telephone | 512-483-9569
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Fax | 124-066-2165
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J9384
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License Number State | TX
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