Provider Demographics
NPI:1659340180
Name:REDDY, ANNE M (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 HIGHWAY 36 W STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3905
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI461582085R0202X
MN503202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN943381052811OtherPREFERRED ONE
MN54R74REOtherBLUE CROSS AND BLUE SHIELD OF MN
MN161312OtherUCARE
MN1659340180OtherMEDICA
WI34440100Medicaid
MN37M86REOtherBLUE CROSS AND BLUE SHIELD OF MINNESOTA
MN520049100Medicaid
MN960371052811OtherPREFERRED ONE
IA1659340180Medicaid
MNHP79273OtherHEALTHPARTNERS
WI34440100Medicaid
WI007304070Medicare PIN
MN960371052811OtherPREFERRED ONE
MN300004470Medicare PIN
MNG83308Medicare UPIN