MEDICARE: BAMENDA HEALTH, LLC

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

General Provider Information

NPI Number	:	1417611765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAMENDA HEALTH, LLC

Provider Business Mailing Address
First Line	:	924 E HYDE PARK BLVD UNIT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2728
Country	:	US
Telephone Number	:	214-566-8175
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 E HYDE PARK BLVD UNIT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2728
Country	:	US
Telephone Number	:	214-566-8175
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. AJAY K REDDY
Credential	:	INTERNAL MEDICINE
Telephone Number	:	214-566-8175

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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Directions to “BAMENDA HEALTH, LLC ” Practice Location

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