Provider Demographics
NPI:1679590616
Name:REDDY, PRAFUL ANUGU (MD)
Entity Type:Individual
Prefix:
First Name:PRAFUL
Middle Name:ANUGU
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 1:6677 W THUNDERBIRD RD STE D148
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3769
Mailing Address - Country:US
Mailing Address - Phone:602-843-3811
Mailing Address - Fax:602-843-0044
Practice Address - Street 1:6677 W THUNDERBIRD RD STE D148
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3769
Practice Address - Country:US
Practice Address - Phone:602-843-3811
Practice Address - Fax:602-843-0044
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26809207Q00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432823Medicaid
AZG74830Medicare UPIN
AZ432823Medicaid