Provider Demographics
NPI:1255517561
Name:MALIREDDY, SRIKAR R (MD)
Entity type:Individual
Prefix:DR
First Name:SRIKAR
Middle Name:R
Last Name:MALIREDDY
Suffix:
Gender:M
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5400 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-691-8271
Practice Address - Fax:940-692-2042
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061129A207R00000X
IN01061129207R00000X
TXL7469207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00975255OtherRAILROAD MEDICARE
TX160931502Medicaid
OR200522490AMedicaid
IN200892730Medicaid
INP00478524OtherRAILROAD MEDICARE
IN000000550635OtherANTHEM
TX200522490AMedicaid
TX160931502Medicaid
IN070860NNNNMedicare PIN
IN267030NNMedicare PIN
IN165460D1Medicare PIN