Provider Demographics
NPI:1760480883
Name:REDDY, INDIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:
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 1:37399 GARFIELD RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3659
Mailing Address - Country:US
Mailing Address - Phone:586-228-3991
Mailing Address - Fax:586-228-2901
Practice Address - Street 1:37399 GARFIELD RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3659
Practice Address - Country:US
Practice Address - Phone:586-228-3991
Practice Address - Fax:586-228-2901
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010055130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4391046Medicaid
MI4391046Medicaid
MIF45108Medicare UPIN