MEDICARE: TADUR S REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	ME71506	FL

General Provider Information

NPI Number	:	1023007382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TADUR S REDDY M.D.

Provider Business Mailing Address
First Line	:	9500 KILGORE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5702
Country	:	US
Telephone Number	:	407-876-2180
Fax Number	:	407-447-4274

Provider Business Practice Location Address
First Line	:	4300 CLARCONA OCOEE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4114
Country	:	US
Telephone Number	:	407-292-0292
Fax Number	:	407-447-4274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/09/2007

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