MEDICARE: SRIKANTH KOTTAPALLY 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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	2073307	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250012255	OTHER	OK	RAILROAD MEDICARE
2	P00216400	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1912934100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRIKANTH KOTTAPALLY REDDY MD

Provider Business Mailing Address
First Line	:	4802 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5822
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-392-1488

Provider Business Practice Location Address
First Line	:	4812 S 109TH EAST AVE
Second Line	:	SUITE 300
City	:	TULSA
State	:	OK
Zip	:	74146-5826
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-236-4587

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/21/2017

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