MEDICARE: GIREESH REDDY DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	3016	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	213E00000X	Podiatrist	3016	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	412982702	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1366976748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIREESH REDDY DPM

Provider Business Mailing Address
First Line	:	4100 W 15TH ST STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5826
Country	:	US
Telephone Number	:	469-573-3427
Fax Number	:	469-361-4361

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5826
Country	:	US
Telephone Number	:	469-573-3427
Fax Number	:	469-361-4361

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	08/19/2024

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Directions to “ GIREESH REDDY DPM” Practice Location

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