Individual
MAHENDRANATH REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27211 LAHSER RD, SUITE # 200, SOUTHFIELD, MI 48034-8469
(248) 358-4892
(248) 358-5125
Mailing address
2799 W. GRAND BLVD, HENRY FORD HOSPITAL, CFP-5 DEPT OF NEPHROLOGY,, DETROIT, MI 48202
(313) 916-2710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MR084085
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F336360
BCBSM
MI
01
—
1346398971
GROUP NPI
MI
01
—
205485614
TAX ID
MI
01
—
207R00000X
TAXONOMY
MI
01
—
4301084085
LICENSE
MI
Enumeration date
06/21/2007
Last updated
05/17/2012
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