Healthcare Provider Details

I. General information

NPI: 1740576800
Provider Name (Legal Business Name): DEEPTI G. REDDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LITTLE LAKE DR STE 10
ANN ARBOR MI
48103-6218
US

IV. Provider business mailing address

210 LITTLE LAKE DR STE 10
ANN ARBOR MI
48103-6218
US

V. Phone/Fax

Practice location:
  • Phone: 734-332-9936
  • Fax: 206-666-2989
Mailing address:
  • Phone: 734-332-9936
  • Fax: 206-666-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301098843
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: