Individual
DR. SIREEN THEGALAPALLE REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
205 N EAST AVE, IMAGING SERVICES, JACKSON, MI 49201-1753
(517) 783-2612
(517) 783-5991
Mailing address
PO BOX 905, JACKSON, MI 49204-0905
(517) 783-2612
(517) 783-5991
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301106438
MI
2085R0204X
Vascular & Interventional Radiology Physician
4301106438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-117273
036-117273
IL
01
—
4301106438
MICHIGAN MEDICAL LICENSE
MI
Enumeration date
08/01/2008
Last updated
12/20/2019
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