Provider Demographics
NPI:1497725626
Name:REDDY, LAVANYA (MD)
Entity Type:Individual
Prefix:
First Name:LAVANYA
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 1:28755 SCHOENHERR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4395
Mailing Address - Country:US
Mailing Address - Phone:586-573-7222
Mailing Address - Fax:586-573-7267
Practice Address - Street 1:28755 SCHOENHERR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4395
Practice Address - Country:US
Practice Address - Phone:586-573-7222
Practice Address - Fax:586-573-7267
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301031555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3095920Medicaid
MI5199932Medicaid
MI3095920Medicaid
MI5199932Medicaid