MEDICARE: DR. JAMUNA REDDY GARISA M.D.,

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	208000000X	Pediatrics Physician	125.066527	IL

General Provider Information

NPI Number	:	1124474598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMUNA REDDY GARISA M.D.,

Provider Business Mailing Address
First Line	:	1926 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3737
Country	:	US
Telephone Number	:	312-391-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3737
Country	:	US
Telephone Number	:	312-391-3443
Fax Number	:

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

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	08/31/2020

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