Provider Demographics
NPI:1992737084
Name:REDDY, CHITTARANJAN VENKAT (MD)
Entity type:Individual
Prefix:MR
First Name:CHITTARANJAN
Middle Name:VENKAT
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86339-0563
Mailing Address - Country:US
Mailing Address - Phone:262-788-9229
Mailing Address - Fax:262-788-9241
Practice Address - Street 1:3310 W CHARTWELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-693-2249
Practice Address - Fax:309-693-2583
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.090651207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE92853Medicare UPIN
ILIL6422001Medicare PIN
ILE92853Medicare UPIN
ILIL6422001Medicare PIN