Healthcare Provider Details

I. General information

NPI: 1124313861
Provider Name (Legal Business Name): RAJAMATHIAS Y REDDY MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 KIMOLE LN STE B3
ADRIAN MI
49221-1491
US

IV. Provider business mailing address

901 KIMOLE LN STE B3
ADRIAN MI
49221-1491
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-7337
  • Fax: 517-263-6150
Mailing address:
  • Phone: 517-263-7337
  • Fax: 517-263-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRR066814
License Number StateMI

VIII. Authorized Official

Name: DR. RAJAMATHIAS Y REDDY
Title or Position: PHYSICIAN
Credential: MD
Phone: 517-263-7337