Provider Demographics
NPI:1689664807
Name:REDDY, SREENIVAS GUDDETI (MD)
Entity type:Individual
Prefix:
First Name:SREENIVAS
Middle Name:GUDDETI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SREENIVAS
Other - Middle Name:R
Other - Last Name:GUDDETI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3365
Mailing Address - Country:US
Mailing Address - Phone:708-354-8881
Mailing Address - Fax:708-354-8340
Practice Address - Street 1:7 N GRANT ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3365
Practice Address - Country:US
Practice Address - Phone:708-354-8881
Practice Address - Fax:708-354-8340
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010538782085R0202X, 2085R0204X
IL0360961522085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200339250Medicaid
ILK24846Medicare PIN
IN160160 QMedicare ID - Type Unspecified
ILK30300Medicare PIN
INH30714Medicare UPIN