Individual
SRINIVASA REDDY MADIREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
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
208M00000X
Hospitalist Physician
4301084372
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803314742
BCBSM
MI
01
—
70-0-F32947-0
BCBS CPIN #
MI
01
—
SM084372
STATE LIC#
MI
Enumeration date
06/13/2007
Last updated
12/02/2009
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