Provider Demographics
NPI:1275705691
Name:REDDY, JAGADEESH (MD)
Entity Type:Individual
Prefix:
First Name:JAGADEESH
Middle Name:
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 1:3245 HEALTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-3245
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:
Practice Address - Street 1:707 N MICHIGAN ST
Practice Address - Street 2:STE 400
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1071
Practice Address - Country:US
Practice Address - Phone:574-647-8470
Practice Address - Fax:574-647-8475
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070943A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201163020Medicaid
IN000000932962OtherBCBS BMG BEHAVIORAL HEALTH ELKHART
IN000000839927OtherBCBS BMG BEHAVIORAL HEALTH
IN201163020Medicaid
IN178420010Medicare PIN
IN000000874687OtherBCBS BMG CENTENNIAL NEIGHBORHOOD HEALTH
IN236040135Medicare PIN