Provider Demographics
NPI:1922312636
Name:SRINIVASA REDDY, TEJESH
Entity Type:Individual
Prefix:DR
First Name:TEJESH
Middle Name:
Last Name:SRINIVASA REDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 30TH ST
Mailing Address - Street 2:SUITE 1609
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2137
Mailing Address - Country:US
Mailing Address - Phone:402-280-5250
Mailing Address - Fax:402-449-5641
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:SUITE 1609
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-5250
Practice Address - Fax:402-449-5641
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP-6365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine