MEDICARE: LALITHA D REDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036104902	IL

General Provider Information

NPI Number	:	1053306597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LALITHA D REDDY MD

Provider Business Mailing Address
First Line	:	412 63RD ST STE 101
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-2000
Country	:	US
Telephone Number	:	630-855-8355
Fax Number	:	312-291-4258

Provider Business Practice Location Address
First Line	:	412 63RD ST STE 101
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516
Country	:	US
Telephone Number	:	630-855-8355
Fax Number	:	312-291-4258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/19/2020

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Directions to “ LALITHA D REDDY MD” Practice Location

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