Healthcare Provider Details

I. General information

NPI: 1508909128
Provider Name (Legal Business Name): CHAKRADHAR C REDDY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36232 GARFIELD RD
CLINTON TWP MI
48035-1128
US

IV. Provider business mailing address

36232 GARFIELD RD
CLINTON TWP MI
48035-1128
US

V. Phone/Fax

Practice location:
  • Phone: 586-791-5210
  • Fax: 586-791-0049
Mailing address:
  • Phone: 586-791-5210
  • Fax: 586-791-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number034413
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PREMLATHA C REDDY
Title or Position: MANAGER
Credential:
Phone: 586-791-5210