Provider Demographics
NPI:1659329084
Name:REDDY, PAVAN GARLAPATY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:GARLAPATY
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 1:14500 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2402
Mailing Address - Country:US
Mailing Address - Phone:734-281-4197
Mailing Address - Fax:734-282-0093
Practice Address - Street 1:14500 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2402
Practice Address - Country:US
Practice Address - Phone:734-281-4197
Practice Address - Fax:734-282-0093
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063732207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0408279532OtherBL;UE CROSS PIN #
MI0408279532OtherBL;UE CROSS PIN #
MIG97177Medicare UPIN