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General NPI Number Information
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NPI Number | 1053306597
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Entity Type | Individual
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Provider Name | LALITHA D REDDY MD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 412 63RD ST STE 101
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City | DOWNERS GROVE
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State | IL
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Zip | 60516
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Country | US
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Telephone | 630-855-8355
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Fax | 312-291-4258
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Provider Business Mailing Address
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Address Line | 412 63RD ST STE 101
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-2000
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Country | US
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Telephone | 630-855-8355
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Fax | 312-291-4258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036104902
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License Number State | IL
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