MEDICARE: SRINIVASA HONAGANAHALLY VENKAT 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	207R00000X	Internal Medicine Physician	34403	AZ

General Provider Information

NPI Number	:	1316933641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVASA HONAGANAHALLY VENKAT REDDY MD

Provider Business Mailing Address
First Line	:	6740 W DEER VALLEY RD
Second Line	:	STE D-107-278
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5953
Country	:	US
Telephone Number	:	623-341-6539
Fax Number	:	623-215-4254

Provider Business Practice Location Address
First Line	:	6740 W DEER VALLEY RD
Second Line	:	STE D-107-278
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5953
Country	:	US
Telephone Number	:	623-341-6539
Fax Number	:	623-215-4254

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	05/22/2008

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