Healthcare Provider Details

I. General information

NPI: 1720059280
Provider Name (Legal Business Name): PREETHAM Y REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E SUITE 320
ROCHESTER HILLS MI
48307-6122
US

IV. Provider business mailing address

1886 W AUBURN RD SUITE 400
ROCHESTER HILLS MI
48309-3865
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-3345
  • Fax: 248-293-3368
Mailing address:
  • Phone: 248-290-3111
  • Fax: 248-290-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301072073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: