Provider Demographics
NPI:1720069040
Name:REDDY, ASHOK Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:Y
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 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-323-4200
Practice Address - Fax:586-843-3940
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063294208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06273OtherBCBSM
MICB9133OtherRAILROAD MEDICARE
MICB9133OtherRAILROAD MEDICARE
MI0219690001Medicare NSC
MI0E06273OtherBCBSM