Provider Demographics
NPI:1164483855
Name:REDDY, CAROL F (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:F
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15101 E ILIFF AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-996-9601
Mailing Address - Fax:303-369-2605
Practice Address - Street 1:15101 E ILIFF AVE
Practice Address - Street 2:STE 140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-996-9601
Practice Address - Fax:303-369-2605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233998Medicaid
E93465Medicare UPIN
CO346258Medicare ID - Type Unspecified