MEDICARE: MR. SIVAREDDY TEGULAPALLE MD

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	207RG0100X	Gastroenterology Physician	4301045341	MI
2	207RG0100X	Gastroenterology Physician	C157742	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245302660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIVAREDDY TEGULAPALLE MD

Provider Business Mailing Address
First Line	:	266 S HARVARD BLVD STE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4884
Country	:	US
Telephone Number	:	213-387-9000
Fax Number	:	213-387-5804

Provider Business Practice Location Address
First Line	:	266 S HARVARD BLVD STE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4884
Country	:	US
Telephone Number	:	213-387-9000
Fax Number	:	213-387-5804

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/21/2019

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