Individual
DR. BOUYELLA H REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 36TH AVENUE, MOLINE, IL 61265
(309) 743-6700
(309) 743-6709
Mailing address
1236 E RUSHOLME ST, DAVENPORT, IA 52803-2434
(563) 324-2992
(563) 324-8562
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
036097680
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097680
—
IL
05
—
7168971
—
IA
01
—
P00180524
MEDICARE RAILROAD
—
Enumeration date
01/11/2006
Last updated
02/10/2021
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