MEDICARE: PRATHYUSHA PAGADALA 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	207R00000X	Internal Medicine Physician	04-48210	KS
2	207R00000X	Internal Medicine Physician	2025014322	MO
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	2025014322	MO
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	04-48210	KS

General Provider Information

NPI Number	:	1265827406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATHYUSHA PAGADALA MD

Provider Business Mailing Address
First Line	:	2000 OLATHE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8505
Country	:	US
Telephone Number	:	913-588-6022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 OLATHE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-2806
Country	:	US
Telephone Number	:	913-588-6022
Fax Number	:

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

Provider Enumeration Date	:	04/04/2015
Last Update Date	:	08/01/2025

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