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General NPI Number Information
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NPI Number | 1366927493
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Entity Type | Organization
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Legal Business Name | REDDY DERMATOLOGY, S CORPORATION
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 08/31/2020
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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 | 60516-2000
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Country | US
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Telephone | 630-855-8355
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Fax |
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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 | 815-210-1885
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERENCE CHIRAMEL
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Credential | MBBS, MBA
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Telephone | 630-855-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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