1386645299 NPI number — DR. BASIVI REDDY BADDIGAM MD

Table of content: DR. BASIVI REDDY BADDIGAM MD (NPI 1386645299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386645299 NPI number — DR. BASIVI REDDY BADDIGAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADDIGAM
Provider First Name:
BASIVI
Provider Middle Name:
REDDY
Provider Name Prefix Text:
DR.
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:
1386645299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-7002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-466-9718
Provider Business Mailing Address Fax Number:
586-466-9961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43211 DALCOMA DR
Provider Second Line Business Practice Location Address:
STE. 3
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-6309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-6812
Provider Business Practice Location Address Fax Number:
586-263-6835
Provider Enumeration Date:
08/02/2005

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: 2084P0804X , with the licence number:  4301053679 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 4301053679 , 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: 1082559 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1536832 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138868 . This is a "CARECHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 045965 . This is a "VALUEOPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2605021781 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0501753 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4769047-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 819269000 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F46966 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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