MEDICARE: DR. JYOTHIRMAI K REDDY 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	207V00000X	Obstetrics & Gynecology Physician	01040388A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275515801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JYOTHIRMAI K REDDY M.D.

Provider Business Mailing Address
First Line	:	7802 W. JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804
Country	:	US
Telephone Number	:	260-625-6636
Fax Number	:	260-459-6625

Provider Business Practice Location Address
First Line	:	7802 W. JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804
Country	:	US
Telephone Number	:	260-625-6636
Fax Number	:	260-459-6625

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	05/23/2012

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