Healthcare Provider Details

I. General information

NPI: 1174503221
Provider Name (Legal Business Name): SESHAGIRI DANDAMUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COLLEGE ST SUITE B
BATTLE CREEK MI
49037-3461
US

IV. Provider business mailing address

126 COLLEGE ST. SUITE D
BATTLE CREEK MI
49037-2331
US

V. Phone/Fax

Practice location:
  • Phone: 269-968-3030
  • Fax: 269-968-2103
Mailing address:
  • Phone: 269-969-8920
  • Fax: 269-224-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberSD040021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: