MEDICARE: DR. KOTA JAGDISH REDDY 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	207RC0000X	Cardiovascular Disease Physician	K2568	TX

General Provider Information

NPI Number	:	1275565236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOTA JAGDISH REDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 2566
Second Line	:
City	:	SUGARLAND
State	:	TX
Zip	:	77487-2566
Country	:	US
Telephone Number	:	281-491-0044
Fax Number	:	713-777-8617

Provider Business Practice Location Address
First Line	:	3519 TOWN CENTER BLVD S
Second Line	:
City	:	SUGARLAND
State	:	TX
Zip	:	77479
Country	:	US
Telephone Number	:	281-491-0044
Fax Number	:	713-777-8617

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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