Provider Demographics
NPI:1023007382
Name:REDDY, TADUR S (MD)
Entity Type:Individual
Prefix:
First Name:TADUR
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9500 KILGORE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5702
Mailing Address - Country:US
Mailing Address - Phone:407-876-2180
Mailing Address - Fax:407-447-4274
Practice Address - Street 1:4300 CLARCONA OCOEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4114
Practice Address - Country:US
Practice Address - Phone:407-292-0292
Practice Address - Fax:407-447-4274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME71506207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD17565Medicare UPIN