Provider Demographics
NPI:1366927493
Name:REDDY DERMATOLOGY, S CORPORATION
Entity type:Organization
Organization Name:REDDY DERMATOLOGY, S CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS, MBA
Authorized Official - Phone:630-855-8355
Mailing Address - Street 1:412 63RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2000
Mailing Address - Country:US
Mailing Address - Phone:815-210-1885
Mailing Address - Fax:
Practice Address - Street 1:412 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2000
Practice Address - Country:US
Practice Address - Phone:630-855-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty