MEDICARE: SYAM P REDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1780652180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYAM P REDDY MD

Provider Business Mailing Address
First Line	:	37241 EAGLE WAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 W 95 ST
Second Line	:
City	:	OAKLAWN
State	:	IL
Zip	:	60453
Country	:	US
Telephone Number	:	708-684-5520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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