Provider Demographics
NPI:1215134630
Name:MALLAREDDY, MADHAVI (MD)
Entity type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:MALLAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2811 DUKE OF GLOUCESTER ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2017
Mailing Address - Country:US
Mailing Address - Phone:972-274-5555
Mailing Address - Fax:972-274-5663
Practice Address - Street 1:2698 N GALLOWAY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6383
Practice Address - Country:US
Practice Address - Phone:972-681-4444
Practice Address - Fax:214-635-3868
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN3859207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140783Medicare PIN