Provider Demographics
NPI:1629017611
Name:REDDY, NARAYAN KASWARAM (MD,)
Entity Type:Individual
Prefix:
First Name:NARAYAN
Middle Name:KASWARAM
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:KASWARAM
Other - Middle Name:NARAYAN
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:ROOSEVELT RD AND 5TH AVE
Mailing Address - Street 2:HINES
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5000
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-2281
Practice Address - Street 1:ROOSEVELT RD AND 5TH AVE
Practice Address - Street 2:HINES
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2281
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-049634208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation