Healthcare Provider Details

I. General information

NPI: 1326219213
Provider Name (Legal Business Name): RAGHU M REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 06/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LILE DRIVE
LITTLE ROCK AR
72205-6217
US

IV. Provider business mailing address

10001 LILE DRIVE
LITTLE ROCK AR
72205-6217
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-6830
  • Fax: 501-552-5339
Mailing address:
  • Phone: 501-552-6830
  • Fax: 501-552-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-5597
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberE-5597
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-5597
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: