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General NPI Number Information
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NPI Number | 1417611765
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Entity Type | Organization
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Legal Business Name | BAMENDA HEALTH, LLC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 924 E HYDE PARK BLVD UNIT 3W
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City | CHICAGO
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State | IL
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Zip | 60615-2728
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Country | US
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Telephone | 214-566-8175
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Fax |
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Provider Business Mailing Address
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Address Line | 924 E HYDE PARK BLVD UNIT 3W
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City | CHICAGO
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State | IL
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Zip | 60615-2728
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Country | US
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Telephone | 214-566-8175
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. AJAY K REDDY
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Credential | INTERNAL MEDICINE
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Telephone | 214-566-8175
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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 |
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License Number State |
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