MEDICARE: DR. PRATHIMA NAGIREDDY 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	036-148418	IL
2	2083P0901X	Public Health & General Preventive Medicine Physician	148418	IL
3	208D00000X	General Practice Physician	75992	GA
4	2083P0901X	Public Health & General Preventive Medicine Physician	T4011	TX

General Provider Information

NPI Number	:	1306133731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRATHIMA NAGIREDDY M.D

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	323-467-7119

Provider Business Practice Location Address
First Line	:	400 N BEACH ST STE 104
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-7070
Country	:	US
Telephone Number	:	817-831-1750
Fax Number	:

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	05/02/2024

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