1861288854 NPI number — UNKNOWN SADHU AISHWARYA REDDY MBBS

Table of content: (NPI 1144008814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861288854 NPI number — UNKNOWN SADHU AISHWARYA REDDY MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADHU AISHWARYA REDDY
Provider First Name:
UNKNOWN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
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:
1861288854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/26/2026
NPI Reactivation Date:
02/19/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 MEDICAL CENTRE DRIVE MCHENRY IL 60050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCHENRY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-253-8235
Provider Business Mailing Address Fax Number:
815-759-8255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 MEDICAL CENTRE DRIVE MCHENRY IL 60050
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCHENRY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-344-5000
Provider Business Practice Location Address Fax Number:
815-759-8255
Provider Enumeration Date:
04/16/2025

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: 207R00000X , with the licence number:  125085941 , 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)