Individual
BANDA P REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Mailing address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301032390
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0615038941
BLUE CROSS BLUE SHIELD
MI
05
—
1189553
—
MI
Enumeration date
08/04/2006
Last updated
09/07/2012
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