1336134006 NPI number — DR. JENIFER HARISH T REDDY MD

Table of content: DR. JENIFER HARISH T REDDY MD (NPI 1336134006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336134006 NPI number — DR. JENIFER HARISH T REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
JENIFER
Provider Middle Name:
HARISH T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1336134006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 S HURON PKWY
Provider Second Line Business Mailing Address:
SUITE 2B
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48104-5133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-677-0710
Provider Business Mailing Address Fax Number:
734-677-0810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 S HURON PKWY
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48104-5133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-677-0710
Provider Business Practice Location Address Fax Number:
734-677-0810
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  4301068548 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0708102061 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com