Provider Demographics
NPI:1740576800
Name:REDDY, DEEPTI G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTI
Middle Name:G
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 1:210 LITTLE LAKE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6218
Mailing Address - Country:US
Mailing Address - Phone:734-332-9936
Mailing Address - Fax:206-666-2989
Practice Address - Street 1:210 LITTLE LAKE DR STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6218
Practice Address - Country:US
Practice Address - Phone:734-332-9936
Practice Address - Fax:206-666-2989
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010988432083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0942369OtherBCBSM PROVIDER PIN
MI0942369OtherBCBSM PROVIDER PIN