MEDICARE: HIMABINDU RAMASAHAYA 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	207RR0500X	Rheumatology Physician	M2040	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780658708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIMABINDU RAMASAHAYA REDDY MD

Provider Business Mailing Address
First Line	:	5450 CLEARFORK MAIN ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3562
Country	:	US
Telephone Number	:	817-336-7191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3562
Country	:	US
Telephone Number	:	817-336-7191
Fax Number	:	817-419-8840

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/01/2019

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