Individual
HARSHAVARDHAN TATHIREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, L-579, OC14HO , DEPT OF HEMATOLOGY AND ONCOLOGY, PORTLAND, OR 97239
(503) 494-8311
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-3323
(708) 216-4113
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125055801
IL
207R00000X
Internal Medicine Physician
MD210372
OR
207RH0003X
Hematology & Oncology Physician
Primary
036130674
IL
208M00000X
Hospitalist Physician
036130674
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
06/22/2009
Last updated
10/02/2024
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