Organization
REDDY RHEUMATOLOGY OF NORTHWEST IN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDITH ANNE LONGACRE (ADMINISTRATIVE ASSISTANT)
(219) 736-2922
Entity
Organization
Contact information
Practice address
118 E 90TH DRIVE, MERRILLVILLE, IN 46410-7160
(219) 736-2922
(219) 736-2938
Mailing address
118 E 90TH DRIVE, MERRILLVILLE, IN 46410-7160
(219) 736-2922
(219) 736-2938
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01056231A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000322080
ANTHEM
IN
05
—
200806960
—
IN
01
—
P00173282
RAILROAD MEDICARE
IN
Enumeration date
11/09/2007
Last updated
11/11/2009
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