MEDICARE: SANTHOSH K 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	09019R	LA

General Provider Information

NPI Number	:	1174582233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTHOSH K REDDY M.D

Provider Business Mailing Address
First Line	:	970 N ALEXANDER AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2121
Country	:	US
Telephone Number	:	225-383-6363
Fax Number	:	225-383-6367

Provider Business Practice Location Address
First Line	:	970 N ALEXANDER AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2121
Country	:	US
Telephone Number	:	225-383-6363
Fax Number	:	225-383-6367

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	05/05/2011

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