Provider Demographics
NPI:1891751210
Name:REDDY, SUKANYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUKANYA
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 1:975 E NERGE RD STE N40
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4809
Mailing Address - Country:US
Mailing Address - Phone:630-307-0660
Mailing Address - Fax:847-437-4045
Practice Address - Street 1:975 E NERGE RD STE N40
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4809
Practice Address - Country:US
Practice Address - Phone:630-307-0660
Practice Address - Fax:847-437-4045
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36051673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051673Medicaid
IL01606888OtherBLUECROSS BLUESHIELD
IL363049360OtherCOMMERCIAL
IL363049360OtherCOMMERCIAL
IL01606888OtherBLUECROSS BLUESHIELD