Individual
SREEDHAR REDDY MITTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2425 FAIRLAWN DR, CARTHAGE, MO 64836-3517
(417) 237-0983
Mailing address
2425 FAIRLAWN DR, CARTHAGE, MO 64836-3517
(417) 237-0983
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2022030304
MO
208000000X
Pediatrics Physician
4351045516
MI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/05/2019
Last updated
08/16/2022
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