Provider Demographics
NPI:1174545453
Name:REDDY, GEETHA M (MD)
Entity type:Individual
Prefix:MRS
First Name:GEETHA
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4127
Mailing Address - Country:US
Mailing Address - Phone:847-816-3703
Mailing Address - Fax:847-816-4534
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-816-3703
Practice Address - Fax:847-816-4534
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-12-22
Deactivation Date:2006-12-08
Deactivation Code:
Reactivation Date:2007-05-09
Provider Licenses
StateLicense IDTaxonomies
IL036-100405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004928185OtherBLUE CROSS & BLUE SHIELD
IL113855OtherHEALTH PARTNERS
IL2706821OtherAETNA HMO
IL7394083OtherAETNA NONHMO
GA060067327OtherRAILROAD MEDICARE
IL0834054009OtherCIGNA
IL036100405Medicaid
IL036100405Medicaid
ILK50475Medicare PIN