Provider Demographics
NPI:1457409740
Name:REDDY, S. SETHU KUMAR (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:S. SETHU
Middle Name:KUMAR
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 E CAMPUS DR STE 2104
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-2033
Mailing Address - Country:US
Mailing Address - Phone:989-774-7585
Mailing Address - Fax:989-774-7590
Practice Address - Street 1:1280 E CAMPUS DR STE 2104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-3256
Practice Address - Country:US
Practice Address - Phone:989-774-7585
Practice Address - Fax:989-774-7590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068469207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144212Medicaid
OH0144212Medicaid
OHRE 0783691Medicare ID - Type Unspecified