1386609444 NPI number — NANJAPPA C SADASIVAN MD

Table of content: NANJAPPA C SADASIVAN MD (NPI 1386609444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386609444 NPI number — NANJAPPA C SADASIVAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADASIVAN
Provider First Name:
NANJAPPA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386609444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1108
Provider Second Line Business Mailing Address:
ATTN: BARB SIMMONS
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-677-7400
Provider Business Mailing Address Fax Number:
734-677-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2333 BIDDLE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYANDOTTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-677-7400
Provider Business Practice Location Address Fax Number:
734-677-7407
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4301033633 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3009503251 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B45247 . This is a "HEALTH ALLIANCE PLAN NBR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0996742 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 119545 . This is a "SELECTCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1680573 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3009503251 . This is a "BCN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00060426 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11293247 . This is a "CAQH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 321192 . This is a "ULTIMED ID NBR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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