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General NPI Number Information
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NPI Number | 1295802429
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Entity Type | Organization
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Legal Business Name | GEETHA M REDDY S C
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1880 W WINCHESTER RD SUITE 207
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5341
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Country | US
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Telephone | 847-816-3703
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Fax | 847-816-4534
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Provider Business Mailing Address
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Address Line | PO BOX 1127
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-4127
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Country | US
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Telephone | 847-816-3703
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Fax | 847-816-4534
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. GEETHA MUDDASANI REDDY
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Credential | MD
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Telephone | 847-816-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036-100405
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License Number State | IL
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