Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 4351048373 | MI |
NPI | 1033749494 |
---|---|
Provider Name | Aniroodh Tudi Reddy |
First Address | Monroe, MI 48162-7815 |
Second Address | Monroe, MI 48162-7815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 25/06/2021 |