Individual
DR. MAILVAGANAM SRIDHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1521 GULL RD, KALAMAZOO, MI 49048-1640
(269) 226-5165
(269) 226-5166
Mailing address
5943 STADIUM DR, STE 1, KALAMAZOO, MI 49009-3016
(269) 552-2836
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301078343
MI
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
4301078343
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110223577
METRAHEALTH RR
MI
01
—
382567464050
COMMUNITY CHOICE MI
MI
05
—
4316669
—
MI
01
—
700F325300
BCN
MI
01
—
MS078343
BCBS OF MI
MI
01
—
P00261670
METRAHEALTH RR
MI
Enumeration date
05/10/2006
Last updated
09/29/2016
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