Individual
PRODDUTUR VITTAL REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
925 NW 15TH AVE, ARDMORE, OK 73401-1809
(580) 223-0011
Mailing address
925 NW 15TH AVE, ARDMORE, OK 73401-1809
(580) 223-0011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11121
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100181280A
—
OK
Enumeration date
11/09/2006
Last updated
07/15/2010
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