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General NPI Number Information
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NPI Number | 1023267945
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Entity Type | Organization
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Legal Business Name | VLSR MADIREDDY MD PC
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 4129 OKEMOS RD STE 6
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City | OKEMOS
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State | MI
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Zip | 48864-2822
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Country | US
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Telephone | 517-803-4544
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Fax | 517-803-4509
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Provider Business Mailing Address
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Address Line | 1715 HAMILTON DR
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City | BLOOMFIELD
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State | MI
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Zip | 48302-0222
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Country | US
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Telephone | 517-803-4544
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Fax | 517-803-4509
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SRINIVASA R MADIREDDY
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Credential | MD
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Telephone | 248-214-1576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 4301084372
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License Number State | MI
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