Basic Information
| Provider Information | |||||||||
| NPI: | 1467614610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATAGARI | ||||||||
| FirstName: | PRADEEP | ||||||||
| MiddleName: | REDDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5012 S US HWY 75 SUITE 300 | ||||||||
| Address2: | ATTN BILLING | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034163000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 N CORNERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034163000 | ||||||||
| FaxNumber: | 9034163001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 55717 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 55717 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.