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NPI Code Detail

MEDICARE: REETHU KUMBLA NAYAK M.D.

MEDICARE: REETHU KUMBLA NAYAK 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
1390200000XStudent in an Organized Health Care Education/Training ProgramBP10059403TX
2207Q00000XFamily Medicine PhysicianS8471TX

General Provider Information

NPI Number : 1962939637
Entity Type Code : Individual
Provider Name (Legal Business Name) : REETHU KUMBLA NAYAK M.D.
Provider Business Mailing Address
First Line : 1739 SCHERTZ PKWY
Second Line :
City : SCHERTZ
State : TX
Zip : 78154-1639
Country : US
Telephone Number : 210-491-8179
Fax Number : 210-590-2664
Provider Business Practice Location Address
First Line : 1739 SCHERTZ PKWY
Second Line :
City : SCHERTZ
State : TX
Zip : 78154-1639
Country : US
Telephone Number : 210-491-8179
Fax Number : 210-590-2664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2017
Last Update Date : 10/09/2020

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