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NPI Code Detail

MEDICARE: PRAKASH V REDDY MD

MEDICARE: PRAKASH V 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
1207RS0012XSleep Medicine (Internal Medicine) PhysicianME83944FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
264150XOTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528043163
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRAKASH V REDDY MD
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 140 6TH AVE
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-3204
Country : US
Telephone Number : 321-312-3501
Fax Number : 321-723-9176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 05/04/2022

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