Provider Demographics
NPI:1508898818
Name:REDDY, CHANDRA S (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S2845 WHITE EAGLE RD
Mailing Address - Street 2:HO-CHUNK HOUSES OF WELLNESS
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-355-0251
Mailing Address - Fax:608-355-9643
Practice Address - Street 1:S2845 WHITE EAGLE RD
Practice Address - Street 2:HO-CHUNK HOUSE OF WELLNESS
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-355-0251
Practice Address - Fax:608-355-9643
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043121207RE0101X
WI47052-20207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8432320Medicaid
WA8432320Medicaid
WAAB11720Medicare ID - Type Unspecified