1639229719 NPI number — ESPRIN REDDY M.D.

Table of content: ESPRIN REDDY M.D. (NPI 1639229719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639229719 NPI number — ESPRIN REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
ESPRIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDDY
Provider Other First Name:
ESPHIRAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639229719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A CAMBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49837-2469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-497-5263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N16088 BALSAM LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPALDING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-497-5263
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007

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: 208D00000X , with the licence number:  4301063991 , 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: 32957900 . This is a "WI MEDICAID GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32958000 . This is a "WI MEDICAID GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 34500400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10062108 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32958100 . This is a "WI MEDICAID GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 382375778005 . This is a "CHAMPUS GROUP" identifier . This identifiers is of the category "OTHER".




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