Provider Demographics
NPI:1467614610
Name:TATAGARI, PRADEEP REDDY
Entity type:Individual
Prefix:
First Name:PRADEEP
Middle Name:REDDY
Last Name:TATAGARI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HAWK WOOD LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2001
Mailing Address - Country:US
Mailing Address - Phone:469-526-3474
Mailing Address - Fax:
Practice Address - Street 1:701 HAWK WOOD LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2001
Practice Address - Country:US
Practice Address - Phone:270-996-7254
Practice Address - Fax:469-526-5628
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI557172084P0800X, 2084P0804X
TXR76092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100018189Medicaid