Provider Demographics
NPI:1942707070
Name:REDDY, ABHISHEK B (MD)
Entity Type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:B
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 DOTY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7509
Mailing Address - Country:US
Mailing Address - Phone:815-206-3400
Mailing Address - Fax:815-206-3435
Practice Address - Street 1:20320 NORTHWEST FWY STE 400
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5643
Practice Address - Country:US
Practice Address - Phone:346-260-5112
Practice Address - Fax:832-376-7541
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036167715208100000X
TXT8635208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program