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General NPI Number Information
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NPI Number | 1972790699
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Entity Type | Organization
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Legal Business Name | SIRISH MADDALI, M.D., INC.
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 390 LAUREL STREET SUITE 205
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-1953
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Country | US
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Telephone | 415-771-7710
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Fax | 415-771-7707
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Provider Business Mailing Address
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Address Line | 390 LAUREL STREET SUITE 205
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-1953
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Country | US
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Telephone | 415-771-7710
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Fax | 415-771-7707
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIRISH MADDALI
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Credential | M.D.
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Telephone | 415-771-7710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A90979
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License Number State | CA
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