MEDICARE: DR. NAGENDRAM PAIDISETTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	036-114717	IL
2	2080N0001X	Neonatal-Perinatal Medicine Physician	33013-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770696338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGENDRAM PAIDISETTY M.D.

Provider Business Mailing Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-4011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-4011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/17/2018

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