Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 36110210 | IL |
NPI | 1003847427 |
---|---|
Provider Name | Satish Bollu Reddy |
First Address | Chicago, IL 60657-1428 |
Second Address | Tampa, FL 33607-6383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 28/09/2012 |