Provider Demographics
NPI:1083649545
Name:REDDY, CHANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:N CHANDRA
Other - Middle Name:S
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1854 W AUBURN RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3868
Mailing Address - Country:US
Mailing Address - Phone:248-656-5800
Mailing Address - Fax:248-656-5802
Practice Address - Street 1:1854 W AUBURN RD STE 100B
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3868
Practice Address - Country:US
Practice Address - Phone:248-656-5800
Practice Address - Fax:248-656-5802
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICR031554207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4601887Medicaid
MIMI4989OtherGROUP PTAN
MI1295023547OtherGROUP NPI (MICHIGAN HEALTHCARE PROFESSIONALS PC)
MID90202Medicare UPIN