Provider Demographics
NPI:1053306597
Name:REDDY, LALITHA D (MD)
Entity Type:Individual
Prefix:
First Name:LALITHA
Middle Name:D
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 63RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2000
Mailing Address - Country:US
Mailing Address - Phone:630-855-8355
Mailing Address - Fax:312-291-4258
Practice Address - Street 1:412 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-855-8355
Practice Address - Fax:312-291-4258
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104902207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104902Medicaid
ILK12077Medicare UPIN
IL974040Medicare ID - Type UnspecifiedMEDICARE PROVIDER #