Basic Information
| Provider Information | |||||||||
| NPI: | 1700963519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | LAKSHMI | ||||||||
| MiddleName: | GB | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 W. THUNDERBIRD | ||||||||
| Address2: | BANNER THUNDERBIRD MEDICAL CENTER | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029316331 | ||||||||
| FaxNumber: | 6028652632 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 W. THUNDERBIRD | ||||||||
| Address2: | BANNER THUNDERBIRD MEDICAL CENTER | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029316331 | ||||||||
| FaxNumber: | 6028652632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29540 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 29540 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 10253525-1205 | UT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.