Organization
VLSR MADIREDDY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASA R MADIREDDY MD (PHYSICIAN)
(248) 214-1576
Entity
Organization
Contact information
Practice address
4129 OKEMOS RD, STE 6, OKEMOS, MI 48864-2822
(517) 803-4544
(517) 803-4509
Mailing address
1715 HAMILTON DR, BLOOMFIELD, MI 48302-0222
(517) 803-4544
(517) 803-4509
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
4301084372
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080F369400
BCBSM
MI
01
—
0C30642
BCBSM
MI
01
—
0C30644
BCBSM NPP GRP
MI
05
—
10232267945
—
MI
01
—
DO5269
RR MCR
—
01
—
SM084372
STATE LIC#
MI
Enumeration date
09/16/2008
Last updated
12/09/2013
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