Provider Demographics
NPI:1295802429
Name:GEETHA M REDDY S C
Entity type:Organization
Organization Name:GEETHA M REDDY S C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEETHA
Authorized Official - Middle Name:MUDDASANI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-816-3703
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4127
Mailing Address - Country:US
Mailing Address - Phone:847-816-3703
Mailing Address - Fax:847-816-4534
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-816-3703
Practice Address - Fax:847-816-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004928185OtherBCBS
IL2706821OtherAETNA HMO
IL7394083OtherAETNA NONHMO
IL036100405Medicaid
IL0834054009OtherCIGNA
IL113855OtherHEALTH PARTNERS
GA060067327OtherRAILROAD MEDICARE
IL0004928185OtherBCBS
IL971300Medicare PIN