MEDICARE: MADHUKANTH T. REDDY 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	207R00000X	Internal Medicine Physician	01057549A	IN
2	207RI0200X	Infectious Disease Physician	01057549A	IN
3	208M00000X	Hospitalist Physician	01057549A	IN
4	207RI0200X	Infectious Disease Physician	S1900	TX

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
2	1356319990	OTHER	TX	NPI INDIVIDUAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356319990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHUKANTH T. REDDY M.D.

Provider Business Mailing Address
First Line	:	8528 DAVIS BLVD SITE 134-359
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182
Country	:	US
Telephone Number	:	817-370-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-370-3444
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/06/2019

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