Provider Demographics
NPI:1912978081
Name:REDDY, NAGAMANI P (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGAMANI
Middle Name:P
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 HOBSON RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1442
Mailing Address - Country:US
Mailing Address - Phone:630-515-1050
Mailing Address - Fax:630-515-1051
Practice Address - Street 1:3510 HOBSON RD STE 305
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1442
Practice Address - Country:US
Practice Address - Phone:630-515-1050
Practice Address - Fax:630-515-1051
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360755832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075583Medicaid
IL036075583Medicaid
IL944730Medicare ID - Type Unspecified