Healthcare Provider Details

I. General information

NPI: 1578488896
Provider Name (Legal Business Name): RANDEEP KAUR REDDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12245 ALLISON RD
MILAN MI
48160-9145
US

IV. Provider business mailing address

12245 ALLISON RD
MILAN MI
48160-9145
US

V. Phone/Fax

Practice location:
  • Phone: 734-664-8922
  • Fax:
Mailing address:
  • Phone: 734-664-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAF580338269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: