Individual
NARAYANA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
228 NE JEFFERSON AVE, PEORIA, IL 61603-3802
(309) 671-8000
(309) 671-4695
Mailing address
PO BOX 1346, PEORIA, IL 61654-1346
(309) 671-8000
(309) 671-4695
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036088236
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360882361
—
IL
05
—
0360882362
—
IL
01
—
260025472
RAILROAD MEDICARE
IL
01
—
L34349
MEDICARE ID- TYPE UNSPECIFIED
IL
Enumeration date
06/15/2006
Last updated
05/17/2012
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