Provider Demographics
NPI:1023005840
Name:REDDY, BHASKER (MD)
Entity Type:Individual
Prefix:
First Name:BHASKER
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 N RONALD REAGAN PARKWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6911
Practice Address - Country:US
Practice Address - Phone:317-272-8050
Practice Address - Fax:317-272-8051
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046775A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267030VVOtherMEDICARE PTAN
IN000000668271OtherANTHEM PTAN
IN1102234516OtherANTHEM PTAN
IN200202940Medicaid
IN267030VVMedicare PIN
INP00382648Medicare PIN
INP00871836Medicare PIN