Healthcare Provider Details

I. General information

NPI: 1063494607
Provider Name (Legal Business Name): SRIDHAR CHALASANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/27/2023
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 CAPITAL AVE SW STE A
BATTLE CREEK MI
49015-9411
US

IV. Provider business mailing address

3770 CAPITAL AVE SW SUITE A
BATTLE CREEK MI
49015-9411
US

V. Phone/Fax

Practice location:
  • Phone: 269-441-1771
  • Fax: 269-441-1773
Mailing address:
  • Phone: 269-441-1771
  • Fax: 269-441-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberSC077498
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: