Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 066403 | GA |
Y | 2080P0202X | Pediatric Cardiologist | 2006008763 | MO |
NPI | 1093738916 |
---|---|
Provider Name | Dr. Chetana M Reddy |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003114510C | (05) | GA |
203737200 | (05) | MO |
250358060 | (05) | IL |
OTH000170 | (02) |