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NPI Code Detail

MEDICARE: MYTHILI PALADUGU MD

MEDICARE: MYTHILI PALADUGU 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
1202K00000XPhlebology PhysicianM6326TX
2207L00000XAnesthesiology PhysicianM6326TX

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 : 1528139060
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYTHILI PALADUGU MD
Provider Business Mailing Address
First Line : PO BOX 33434
Second Line :
City : FORT WORTH
State : TX
Zip : 76162-3434
Country : US
Telephone Number : 817-332-8346
Fax Number : 817-332-1723
Provider Business Practice Location Address
First Line : 851 W TERRELL AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3161
Country : US
Telephone Number : 817-332-8346
Fax Number : 817-332-1723
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 01/30/2024

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Directions to “ MYTHILI PALADUGU MD” Practice Location

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