MEDICARE: DR. JENIFER HARISH T 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	4301068548	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0708102061	OTHER		BCBS

General Provider Information

NPI Number	:	1336134006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENIFER HARISH T REDDY MD

Provider Business Mailing Address
First Line	:	2301 S HURON PKWY
Second Line	:	SUITE 2B
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-677-0710
Fax Number	:	734-677-0810

Provider Business Practice Location Address
First Line	:	2301 S HURON PKWY
Second Line	:	SUITE 2B
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-677-0710
Fax Number	:	734-677-0810

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/20/2010

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