Healthcare Provider Details

I. General information

NPI: 1174728885
Provider Name (Legal Business Name): SRIKANTH SADHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR STE 290A
MIDDLETOWN OH
45005-5200
US

IV. Provider business mailing address

200 MEDICAL CENTER DR STE 290A
MIDDLETOWN OH
45005-5200
US

V. Phone/Fax

Practice location:
  • Phone: 513-425-7135
  • Fax: 513-420-4662
Mailing address:
  • Phone: 513-425-7135
  • Fax: 513-420-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number41792
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.098771
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number41792
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: