Individual
MR. JANNA REDDY PATHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 PINE ST, ELDORADO, IL 62930-1634
(618) 273-3361
Mailing address
PO BOX 148, HARTFORD, KY 42347-0148
(270) 298-5417
(270) 298-5285
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036.140240
IL
208600000X
Surgery Physician
Primary
31000
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042142
BCBS
—
01
—
000000538224
ANTHEM
KY
01
—
020025142
RAILROAD MEDICARE
KY
01
—
1065454
PASSPORT
KY
05
—
64310006
—
KY
Enumeration date
01/09/2006
Last updated
02/12/2024
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