Provider Demographics
NPI:1043298136
Name:REDDY, CHADA NATALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADA
Middle Name:NATALIE
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 1:38935 ANN ARBOR ROAD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:7300 CANTON CENTER ROAD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1579
Practice Address - Country:US
Practice Address - Phone:734-454-8002
Practice Address - Fax:734-454-2733
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039083207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043298136Medicaid
11286704OtherCAQH
11286704OtherCAQH