Provider Demographics
NPI:1982873220
Name:MALLADI, PREETI (MD)
Entity Type:Individual
Prefix:DR
First Name:PREETI
Middle Name:
Last Name:MALLADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W COLORADO BLVD STE 829
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2366
Mailing Address - Country:US
Mailing Address - Phone:214-242-9737
Mailing Address - Fax:214-242-9946
Practice Address - Street 1:221 W COLORADO BLVD STE 829
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2366
Practice Address - Country:US
Practice Address - Phone:214-242-9737
Practice Address - Fax:214-242-9946
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120779208600000X
TXN3858208600000X
CAA83258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206421401Medicaid
TX206421401Medicaid