Provider Demographics
NPI:1235291667
Name:REDDY, CHAKRADHAR COOCHCULA (MD)
Entity Type:Individual
Prefix:
First Name:CHAKRADHAR
Middle Name:COOCHCULA
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 1:36232 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035
Mailing Address - Country:US
Mailing Address - Phone:586-791-5210
Mailing Address - Fax:586-791-0049
Practice Address - Street 1:36232 GARFIELD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-791-5210
Practice Address - Fax:586-791-0049
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034413207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301034413OtherPHYSICIAN LICENSE
MI1235291667Medicaid
MI1098717Medicaid