1174545453 NPI number — MRS. GEETHA M REDDY MD

Table of content: MRS. GEETHA M REDDY MD (NPI 1174545453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174545453 NPI number — MRS. GEETHA M REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
GEETHA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
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:
1174545453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/08/2006
NPI Reactivation Date:
05/09/2007

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:
07/24/2006

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: 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 "BLUE CROSS & BLUE SHIELD" 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: 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: 060067327 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0834054009 . This is a "CIGNA" 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".




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