Provider Demographics
NPI:1912948282
Name:REDDY, PADMASHREE B (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMASHREE
Middle Name:B
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMASHREE
Other - Middle Name:S
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 N LOGAN AVE
Mailing Address - Street 2:DANVILLE POLYCLINIC, LTD.
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-477-4716
Mailing Address - Fax:217-444-4965
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:DANVILLE POLYCLINIC, LTD.
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-477-4716
Practice Address - Fax:217-444-4965
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100023560AMedicaid
170576OtherPERSONAL CARE/COVENTRY
897141OtherUNITED HEALTHCARE
IL036083082Medicaid
E88849Medicare UPIN
IL036083082Medicaid
370003025Medicare ID - Type UnspecifiedRAILROAD MEDICARE