1295802429 NPI number — GEETHA M REDDY S C

Table of content: (NPI 1295802429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295802429 NPI number — GEETHA M REDDY S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEETHA M REDDY S C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GEETHA M REDDY MD F A C C
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295802429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-816-3703
Provider Business Mailing Address Fax Number:
847-816-4534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 W WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-816-3703
Provider Business Practice Location Address Fax Number:
847-816-4534
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
GEETHA
Authorized Official Middle Name:
MUDDASANI
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
847-816-3703

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036-100405 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004928185 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2706821 . This is a "AETNA HMO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7394083 . This is a "AETNA NONHMO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036100405 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0834054009 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 113855 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 060067327 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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