MEDICARE: JISSILLE RAMA REDDY PA-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	363A00000X	Physician Assistant	53489	CA
2	363A00000X	Physician Assistant	14508	MN
3	363A00000X	Physician Assistant	085010462	IL

General Provider Information

NPI Number	:	1417306242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JISSILLE RAMA REDDY PA-C

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 HIGHLAND AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1500
Country	:	US
Telephone Number	:	630-275-5900
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	05/12/2026

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Directions to “ JISSILLE RAMA REDDY PA-C” Practice Location

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