Provider Demographics
NPI:1518486927
Name:NAVEEN REDDY PLLC
Entity Type:Organization
Organization Name:NAVEEN REDDY PLLC
Other - Org Name:PALM BEACH GI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-619-7620
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7187
Mailing Address - Country:US
Mailing Address - Phone:561-619-7620
Mailing Address - Fax:561-619-7864
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 106
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7187
Practice Address - Country:US
Practice Address - Phone:561-619-7620
Practice Address - Fax:561-619-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101726600Medicaid