Provider Demographics
NPI:1235442732
Name:PRITHAM P. REDDY, PLLC
Entity Type:Organization
Organization Name:PRITHAM P. REDDY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRITHAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-424-5748
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 555
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-424-5748
Mailing Address - Fax:248-443-1706
Practice Address - Street 1:22250 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE #555
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-424-5748
Practice Address - Fax:248-443-1706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRITHAM REDDY M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010750462086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty