Provider Demographics
NPI:1356319990
Name:REDDY, MADHUKANTH T (MD)
Entity Type:Individual
Prefix:
First Name:MADHUKANTH
Middle Name:T
Last Name:REDDY
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 1:8528 DAVIS BLVD SITE 134-359
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:817-370-3444
Mailing Address - Fax:
Practice Address - Street 1:6551 HARRIS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-370-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057549A207R00000X, 207RI0200X, 208M00000X
TXS1900207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200439870Medicaid
TX1356319990OtherNPI INDIVIDUAL
IN200439870AMedicaid
256480CMedicare PIN
IN465610SSMedicare ID - Type Unspecified
IN200439870AMedicaid