Provider Demographics
NPI:1184712481
Name:REDDY, PRODDUTUR RAGHUVEER (MD)
Entity type:Individual
Prefix:DR
First Name:PRODDUTUR
Middle Name:RAGHUVEER
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 1159
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-5020
Mailing Address - Fax:312-563-2564
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1159
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:312-563-2564
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36109715207RC0000X
PAMD436630207RI0011X
IL036109715207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease