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General NPI Number Information
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NPI Number | 1386645299
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Entity Type | Individual
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Provider Name | BASIVI REDDY BADDIGAM MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 43211 DALCOMA DR STE. 3
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City | CLINTON TWP
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State | MI
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Zip | 48038-6309
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Country | US
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Telephone | 586-263-6812
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Fax | 586-263-6835
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Provider Business Mailing Address
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Address Line | PO BOX 7002
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City | BLOOMFIELD
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State | MI
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Zip | 48302-7002
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Country | US
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Telephone | 586-466-9718
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Fax | 586-466-9961
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 4301053679
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301053679
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License Number State | MI
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