| Vlsr Madireddy Md Pc | |
|
4129 Okemos Rd Ste 6 Okemos MI 48864-2822 | |
| (517) 803-4544 | |
| (517) 803-4509 |
| Full Name | Vlsr Madireddy Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4129 Okemos Rd, Okemos, Michigan |
| Authorized Official Name and Position | Srinivasa R Madireddy (PHYSICIAN) |
| Authorized Official Contact | 2482141576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vlsr Madireddy Md Pc 1715 Hamilton Dr Bloomfield MI 48302-0222 Ph: (517) 803-4544 | Vlsr Madireddy Md Pc 4129 Okemos Rd Ste 6 Okemos MI 48864-2822 Ph: (517) 803-4544 |
| NPI Number | 1023267945 |
|---|---|
| Provider Enumeration Date | 09/16/2008 |
| Last Update Date | 12/09/2013 |
| Medicare PECOS PAC ID | 0042379166 |
|---|---|
| Medicare Enrollment ID | O20081104000726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023267945 | NPI | - | NPPES |
| DO5269 | Other | RR MCR | |
| 10232267945 | Medicaid | MI | |
| 0C30642 | Other | MI | BCBSM |
| 0C30644 | Other | MI | BCBSM NPP GRP |
| SM084372 | Other | MI | STATE LIC# |
| 080F369400 | Other | MI | BCBSM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 4301084372 (Michigan) | Primary |
| Provider Name | Srinivasa R Madireddy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033313069 PECOS PAC ID: 3577643873 Enrollment ID: I20071227000372 |
| Provider Name | Nadir Galal Eldin Abdelrahman |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1417119892 PECOS PAC ID: 1658543517 Enrollment ID: I20111019000159 |
| Provider Name | Gregory Louis Morey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417499294 PECOS PAC ID: 9234408055 Enrollment ID: I20170710001977 |
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