Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036104902 | IL |
NPI | 1053306597 |
---|---|
Provider Name | Lalitha D Reddy |
First Address | Downers Grove, IL 60516-2000 |
Second Address | Downers Grove, IL 60516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 19/08/2020 |