Provider Demographics
NPI:1942356357
Name:REDDY, RAJAGOPAL K (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:RAJAGOPAL
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:773-489-7979
Mailing Address - Fax:773-489-7908
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:773-489-7979
Practice Address - Fax:773-489-7908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-055690207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055690Medicaid
IL31600496OtherBCBS
36-3593720OtherFEIN
ILAR8386357OtherDEA
IL31600496OtherBCBS
IL036055690Medicaid