Provider Demographics
NPI:1639229719
Name:REDDY, ESPRIN (MD)
Entity Type:Individual
Prefix:
First Name:ESPRIN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ESPHIRAN
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1A CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-2469
Mailing Address - Country:US
Mailing Address - Phone:906-497-5263
Mailing Address - Fax:
Practice Address - Street 1:N16088 BALSAM LN
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886
Practice Address - Country:US
Practice Address - Phone:906-497-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063991208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
32957900OtherWI MEDICAID GROUP
WI32958000OtherWI MEDICAID GROUP
WI34500400Medicaid
10062108OtherRAILROAD MEDICARE
WI32958100OtherWI MEDICAID GROUP
382375778005OtherCHAMPUS GROUP
WI32958100OtherWI MEDICAID GROUP
E26016045Medicare UPIN
0E26016Medicare PIN
32957900OtherWI MEDICAID GROUP
231823Medicare Oscar/Certification