Provider Demographics
NPI:1588858815
Name:REDDY, V ARAVIND (MD)
Entity type:Individual
Prefix:DR
First Name:V
Middle Name:ARAVIND
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S 5TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1863
Mailing Address - Country:US
Mailing Address - Phone:815-432-2225
Mailing Address - Fax:815-432-3623
Practice Address - Street 1:625 S 5TH ST STE B
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1863
Practice Address - Country:US
Practice Address - Phone:815-432-2225
Practice Address - Fax:815-432-3623
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0003800069OtherBLUE CROSS BLUE SHIELD
060063395OtherRAILROAD MEDICARE
IN200098830AMedicaid
IL775860OtherMEDICARE PROVIDER
IL036075574Medicaid
14D0981553OtherCLIA
14D0981553OtherCLIA
ILD85612Medicare UPIN
IN200098830AMedicaid