Healthcare Provider Details

I. General information

NPI: 1275764235
Provider Name (Legal Business Name): SWAPNA REDDY ALLAMREDDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 OLD JACKSONVILLE RD
SPRINGFIELD IL
62704-7437
US

IV. Provider business mailing address

2239 E COOK ST
SPRINGFIELD IL
62703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-9722
  • Fax: 217-698-8012
Mailing address:
  • Phone: 217-788-2300
  • Fax: 217-788-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036129424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: