Provider Demographics
NPI:1043306186
Name:V. ARAVIND REDDY M.D.P.C.
Entity Type:Organization
Organization Name:V. ARAVIND REDDY M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:V.
Authorized Official - Middle Name:ARAVIND
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-432-2225
Mailing Address - Street 1:625 S 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1835
Mailing Address - Country:US
Mailing Address - Phone:815-432-2225
Mailing Address - Fax:815-432-3623
Practice Address - Street 1:625 S 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1835
Practice Address - Country:US
Practice Address - Phone:815-432-2225
Practice Address - Fax:815-432-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003800069OtherBLUE CROSS BLUE SHIELD
IL036075574Medicaid
IN200098830AMedicaid
P15192Medicare PIN
D85612Medicare UPIN
060063395Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN200098830AMedicaid