Provider Demographics
NPI:1245302660
Name:TEGULAPALLE, SIVAREDDY (MD)
Entity type:Individual
Prefix:MR
First Name:SIVAREDDY
Middle Name:
Last Name:TEGULAPALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T S.
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:266 S HARVARD BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4884
Mailing Address - Country:US
Mailing Address - Phone:213-387-9000
Mailing Address - Fax:213-387-5804
Practice Address - Street 1:266 S HARVARD BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4884
Practice Address - Country:US
Practice Address - Phone:213-387-9000
Practice Address - Fax:213-387-5804
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045341207RG0100X
CAC157742207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI176566110Medicaid
MIA75317Medicare UPIN
MI0131584Medicare ID - Type Unspecified
MI176566110Medicaid
01315842Medicare PIN