Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | BR073619 | MI |
NPI | 1487628483 |
---|---|
Provider Name | Byra M Reddy |
First Address | Battle Creek, MI 49017-2331 |
Second Address | Saint Joseph, MI 49085-9145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H36348 | (02) | MI |