Provider Demographics
NPI:1548390909
Name:DESIREDDI, NARESH VENKAT (MD)
Entity Type:Individual
Prefix:DR
First Name:NARESH
Middle Name:VENKAT
Last Name:DESIREDDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:
Practice Address - Street 1:101 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5647
Practice Address - Country:US
Practice Address - Phone:512-263-0300
Practice Address - Fax:512-263-0316
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3009208800000X
IL36115854208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206670302Medicaid
TX8CD140Medicare PIN