Healthcare Provider Details

I. General information

NPI: 1861288854
Provider Name (Legal Business Name): UNKNOWN SADHU AISHWARYA REDDY MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date: 01/26/2026
Reactivation Date: 02/19/2026

III. Provider practice location address

4201 MEDICAL CENTRE DRIVE MCHENRY IL 60050
MCHENRY IL
60050
US

IV. Provider business mailing address

4201 MEDICAL CENTRE DRIVE MCHENRY IL 60050
MCHENRY IL
60050
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-5000
  • Fax: 815-759-8255
Mailing address:
  • Phone: 331-253-8235
  • Fax: 815-759-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125085941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: