Provider Demographics
NPI:1871708974
Name:DAS, PAVANI REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:PAVANI
Middle Name:REDDY
Last Name:DAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAVANI
Other - Middle Name:VANGALA
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:910 N LAKE SHORE DR
Mailing Address - Street 2:#720
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1540
Mailing Address - Country:US
Mailing Address - Phone:312-337-8123
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease