Healthcare Provider Details

I. General information

NPI: 1174586267
Provider Name (Legal Business Name): SIVA KUMAR SRIPADA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST SUITE 1815
FLINT MI
48507-2677
US

IV. Provider business mailing address

4800 S SAGINAW ST STE 1815
FLINT MI
48507-2677
US

V. Phone/Fax

Practice location:
  • Phone: 810-275-9152
  • Fax: 810-213-0228
Mailing address:
  • Phone: 810-275-9152
  • Fax: 810-213-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101016685
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5101016685
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101016685
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101016685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: