MEDICARE: DR. SRINIVAS 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	ME81030	FL

General Provider Information

NPI Number	:	1588629091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINIVAS REDDY M.D

Provider Business Mailing Address
First Line	:	3375 WEDGEWOOD LN
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32162-7181
Country	:	US
Telephone Number	:	352-753-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 WEDGEWOOD LN
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32162-7181
Country	:	US
Telephone Number	:	352-753-5522
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/07/2023

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