Provider Demographics
NPI:1568516987
Name:MUMMANENI, REDDIAH BABU (MD)
Entity Type:Individual
Prefix:
First Name:REDDIAH
Middle Name:BABU
Last Name:MUMMANENI
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 1:1401 MEDICAL PKWY STE 412
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5015
Mailing Address - Country:US
Mailing Address - Phone:512-528-7202
Mailing Address - Fax:512-341-7204
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG B STE 313
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-528-7202
Practice Address - Fax:512-341-7204
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP42102084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine