Provider Demographics
NPI:1659428191
Name:SHAH-REDDY, ILA (MD FACP)
Entity Type:Individual
Prefix:DR
First Name:ILA
Middle Name:
Last Name:SHAH-REDDY
Suffix:
Gender:F
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-530-9899
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-552-0286
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID85224Medicare UPIN