MEDICARE: ABHISHEK B 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	208100000X	Physical Medicine & Rehabilitation Physician	T8635	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	036167715	IL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942707070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABHISHEK B REDDY MD

Provider Business Mailing Address
First Line	:	20320 NORTHWEST FWY STE 400
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:	346-260-5112
Fax Number	:	832-376-7541

Provider Business Practice Location Address
First Line	:	20320 NORTHWEST FWY STE 400
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:	346-260-5112
Fax Number	:	832-376-7541

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/09/2025

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