Healthcare Provider Details

I. General information

NPI: 1699338558
Provider Name (Legal Business Name): HITESH RAMESH REDDY MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date: 12/04/2019
Reactivation Date: 12/11/2019

III. Provider practice location address

305 W JACKSON ST STE 206
CARBONDALE IL
62901-1474
US

IV. Provider business mailing address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVENUE, NW
WASHINGTON DC
20060
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-3006
  • Fax: 618-457-3007
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036173993
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036173993
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036173993
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: