Provider Demographics
NPI:1427394782
Name:REDDY FOOT AND ANKLE CENTER CORP
Entity Type:Organization
Organization Name:REDDY FOOT AND ANKLE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDAPUREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-470-2311
Mailing Address - Street 1:2060 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19490
Mailing Address - Country:US
Mailing Address - Phone:610-584-8009
Mailing Address - Fax:610-584-8679
Practice Address - Street 1:2060 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:PA
Practice Address - Zip Code:19490
Practice Address - Country:US
Practice Address - Phone:610-584-8009
Practice Address - Fax:610-584-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
PASC006228261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty