MEDICARE: GEETHA M REDDY S C

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	207RC0000X	Cardiovascular Disease Physician	036-100405	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	060067327	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004928185	OTHER	IL	BCBS
2	2706821	OTHER	IL	AETNA HMO
3	7394083	OTHER	IL	AETNA NONHMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0834054009	OTHER	IL	CIGNA
6	113855	OTHER	IL	HEALTH PARTNERS

General Provider Information

NPI Number	:	1295802429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEETHA M REDDY S C

Provider Business Mailing Address
First Line	:	PO BOX 1127
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-4127
Country	:	US
Telephone Number	:	847-816-3703
Fax Number	:	847-816-4534

Provider Business Practice Location Address
First Line	:	1880 W WINCHESTER RD
Second Line	:	SUITE 207
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5341
Country	:	US
Telephone Number	:	847-816-3703
Fax Number	:	847-816-4534

Authorized Official
Title or Position	:	PROVIDER
Name	:	MRS. GEETHA MUDDASANI REDDY
Credential	:	MD
Telephone Number	:	847-816-3703

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/24/2008

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Directions to “GEETHA M REDDY S C ” Practice Location

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