Provider Demographics
NPI:1013010230
Name:UROSEV-REDDY MD PC
Entity Type:Organization
Organization Name:UROSEV-REDDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:UROSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-776-5777
Mailing Address - Street 1:21225 KELLY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3100
Mailing Address - Country:US
Mailing Address - Phone:586-776-5777
Mailing Address - Fax:586-776-9451
Practice Address - Street 1:21225 KELLY RD
Practice Address - Street 2:STE 3
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3100
Practice Address - Country:US
Practice Address - Phone:586-776-5777
Practice Address - Fax:586-776-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1505739OtherBCBSM
MI1189553Medicaid
MI1190840Medicaid
MI1503894OtherBCBSM
D91414Medicare UPIN
MI1503894Medicare ID - Type Unspecified
MI1503894OtherBCBSM
MI0P35910Medicare ID - Type Unspecified
MI1189553Medicaid