Provider Demographics
NPI:1811420763
Name:REDDY, PRASHANTH NALLU (MD)
Entity type:Individual
Prefix:DR
First Name:PRASHANTH
Middle Name:NALLU
Last Name:REDDY
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 1:2000 S WHEELING AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5642
Mailing Address - Country:US
Mailing Address - Phone:918-747-5200
Mailing Address - Fax:918-858-0290
Practice Address - Street 1:2000 S WHEELING AVE STE 510
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5642
Practice Address - Country:US
Practice Address - Phone:918-747-5200
Practice Address - Fax:918-858-0290
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1820207R00000X, 207RN0300X
390200000X
TX390200000X
OK44509207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program