MEDICARE: DR. NIKALESH 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
1	208600000X	Surgery Physician	003917	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME144107	FL
3	208600000X	Surgery Physician	ME144107	FL

General Provider Information

NPI Number	:	1619280534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKALESH REDDY MD

Provider Business Mailing Address
First Line	:	713 E MARION AVE STE 121
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3862
Country	:	US
Telephone Number	:	203-434-1533
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 E MARION AVE STE 121
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3862
Country	:	US
Telephone Number	:	203-434-1533
Fax Number	:

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	08/23/2024

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