# DR. SAMIR GADEPALLI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1619197555
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 25MA08054700 | NJ | — |
| 208600000X | Surgery Physician | 4301091753 | MI | — |
| 2086S0102X | Surgical Critical Care Physician | 4301091753 | MI | — |
| 2086S0120X | Pediatric Surgery Physician | 35.120317 | OH | — |
| 2086S0120X | Pediatric Surgery Physician | 4301091753 | MI | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 09/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0076036 | — | OH |