Provider Demographics
NPI:1427044981
Name:REDDY, SUSHMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5744 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2815
Mailing Address - Country:US
Mailing Address - Phone:586-871-0473
Mailing Address - Fax:810-385-9216
Practice Address - Street 1:5744 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-2815
Practice Address - Country:US
Practice Address - Phone:586-871-0473
Practice Address - Fax:810-385-9216
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00027166207RE0101X
CAC170924207RE0101X
FLME118322207RE0101X
MI4301049962207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110175127OtherRAILROAD MEDICARE
MI2750251Medicaid
MI1107400641OtherBLUE CROSS BLUE SHIELD
MI1107400641OtherBLUE CROSS BLUE SHIELD