Healthcare Provider Details

I. General information

NPI: 1396723565
Provider Name (Legal Business Name): DARAM H REDDY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GREENWOOD AVE
WAUKEGAN IL
60087
US

IV. Provider business mailing address

609 GREENWOOD AVE
WAUKEGAN IL
60087
US

V. Phone/Fax

Practice location:
  • Phone: 847-336-2525
  • Fax: 847-244-6799
Mailing address:
  • Phone: 847-336-2525
  • Fax: 847-244-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DARAM H REDDY
Title or Position: OWNER
Credential: MD
Phone: 847-336-2525