Provider Demographics
NPI:1366976748
Name:REDDY, GIREESH (DPM)
Entity type:Individual
Prefix:
First Name:GIREESH
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W 15TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5826
Mailing Address - Country:US
Mailing Address - Phone:469-573-3427
Mailing Address - Fax:469-361-4361
Practice Address - Street 1:4100 W 15TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5826
Practice Address - Country:US
Practice Address - Phone:469-573-3427
Practice Address - Fax:469-361-4361
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3016213ES0103X, 213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX412982701Medicaid
TX412982702OtherCSHCN