Healthcare Provider Details

I. General information

NPI: 1124015698
Provider Name (Legal Business Name): MADHU SASIDHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE RESPIRATORY INSTITUTE: DESK A-90
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE RESPIRATORY INSTITUTE: DESK A-90
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-1838
  • Fax:
Mailing address:
  • Phone: 216-445-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.091107
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.091107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: