Basic Information
| Provider Information | |||||||||
| NPI: | 1659340180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2355 HIGHWAY 36 W STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551133905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512922000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2355 HIGHWAY 36 W STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551133905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512922000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 46158 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 50320 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 943381052811 | 01 | MN | PREFERRED ONE | OTHER | 54R74RE | 01 | MN | BLUE CROSS AND BLUE SHIELD OF MN | OTHER | 161312 | 01 | MN | UCARE | OTHER | 1659340180 | 01 | MN | MEDICA | OTHER | 34440100 | 05 | WI | MEDICAID | 37M86RE | 01 | MN | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | OTHER | 520049100 | 05 | MN | MEDICAID | 960371052811 | 01 | MN | PREFERRED ONE | OTHER | 1659340180 | 05 | IA | MEDICAID | HP79273 | 01 | MN | HEALTHPARTNERS | OTHER |