Healthcare Provider Details

I. General information

NPI: 1710909478
Provider Name (Legal Business Name): ST CLAIR PULMONARY & CRITICAL CARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ELECTRIC AVE
PORT HURON MI
48060-6575
US

IV. Provider business mailing address

2615 ELECTRIC AVE
PORT HURON MI
48060-6575
US

V. Phone/Fax

Practice location:
  • Phone: 810-990-8222
  • Fax: 810-937-5592
Mailing address:
  • Phone: 810-990-8222
  • Fax: 810-937-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PODDUTURU SRIDHAR REDDY
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 810-990-8222