Basic Information
| Provider Information | |||||||||
| NPI: | 1255517561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALIREDDY | ||||||||
| FirstName: | SRIKAR | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722342987 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 KELL BLVD | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763101610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406918271 | ||||||||
| FaxNumber: | 9406922042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01061129A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01061129 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | L7469 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | L7469 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | P00975255 | 01 | TX | RAILROAD MEDICARE | OTHER | 160931502 | 05 | TX | MEDICAID | 200522490A | 05 | OR | MEDICAID | 200892730 | 05 | IN | MEDICAID | P00478524 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000550635 | 01 | IN | ANTHEM | OTHER | 200522490A | 05 | TX | MEDICAID |