Provider Demographics
NPI:1932275773
Name:VC REDDY MD & SS DANDAMUDI MD PC
Entity Type:Organization
Organization Name:VC REDDY MD & SS DANDAMUDI MD PC
Other - Org Name:TUSCOLA PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALLURU
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-893-5541
Mailing Address - Street 1:714 S TRUMBULL
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4217
Mailing Address - Country:US
Mailing Address - Phone:989-893-5541
Mailing Address - Fax:989-893-5543
Practice Address - Street 1:714 S TRUMBULL
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4217
Practice Address - Country:US
Practice Address - Phone:989-893-5541
Practice Address - Fax:989-893-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060138207R00000X
MI4301041316207R00000X
MI4301030755207R00000X
MI4301030754207R00000X
MI4301066522207R00000X
MI4301041360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47071Medicare ID - Type Unspecified
VR041360Medicare UPIN