Provider Demographics
NPI:1609036409
Name:REDDY, SRIKAR T (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKAR
Middle Name:T
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21811 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2793
Mailing Address - Country:US
Mailing Address - Phone:586-649-3388
Mailing Address - Fax:586-842-3766
Practice Address - Street 1:21811 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2793
Practice Address - Country:US
Practice Address - Phone:586-649-3388
Practice Address - Fax:586-842-3766
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1241005Medicare PIN