MEDICARE: DR. SUSHMA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	00027166	WA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	C170924	CA
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME118322	FL
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	4301049962	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110175127	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1107400641	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427044981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSHMA REDDY MD

Provider Business Mailing Address
First Line	:	5744 LAKESHORE RD
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-2815
Country	:	US
Telephone Number	:	586-871-0473
Fax Number	:	810-385-9216

Provider Business Practice Location Address
First Line	:	5744 LAKESHORE RD
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-2815
Country	:	US
Telephone Number	:	586-871-0473
Fax Number	:	810-385-9216

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	02/18/2021

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Directions to “ DR. SUSHMA REDDY MD” Practice Location

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