Provider Demographics
NPI:1003104605
Name:MUSKULA, PREETHAM REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PREETHAM
Middle Name:REDDY
Last Name:MUSKULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5934
Mailing Address - Country:US
Mailing Address - Phone:903-595-5514
Mailing Address - Fax:903-262-3715
Practice Address - Street 1:2608 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5934
Practice Address - Country:US
Practice Address - Phone:903-595-5514
Practice Address - Fax:903-262-3715
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059036207R00000X
IL036135787207R00000X
IL036.135787207RC0000X, 207RI0011X
TXT4009207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease