MEDICARE: DR. PREETI MALLADI 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	208600000X	Surgery Physician	036.120779	IL
2	208600000X	Surgery Physician	N3858	TX
3	208600000X	Surgery Physician	A83258	CA

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

General Provider Information

NPI Number	:	1982873220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREETI MALLADI M.D.

Provider Business Mailing Address
First Line	:	221 W COLORADO BLVD STE 829
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2366
Country	:	US
Telephone Number	:	214-242-9737
Fax Number	:	214-242-9946

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD STE 829
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2366
Country	:	US
Telephone Number	:	214-242-9737
Fax Number	:	214-242-9946

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	08/14/2023

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