Individual
JAGADEESH REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
707 N MICHIGAN ST, STE 400, SOUTH BEND, IN 46601-1071
(574) 647-8470
(574) 647-8475
Mailing address
3245 HEALTH DRIVE, SUITE 100, GRANGER, IN 46530-3245
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01070943A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01070943A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201163020
—
IN
Enumeration date
03/26/2008
Last updated
04/28/2023
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