Provider Demographics
NPI:1639141617
Name:REDDY, MOSALI SANJEEVA (MD)
Entity Type:Individual
Prefix:
First Name:MOSALI
Middle Name:SANJEEVA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:STE 300
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-557-8500
Mailing Address - Fax:563-589-4050
Practice Address - Street 1:1515 DELHI ST
Practice Address - Street 2:STE 300
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6320
Practice Address - Country:US
Practice Address - Phone:563-557-8500
Practice Address - Fax:563-589-4050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20918207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161505Medicaid
IL4952165017Medicaid
WI30194600Medicaid
IA0161505Medicaid
IAE70340Medicare UPIN