Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 4301055094 | MI |
NPI | 1003816331 |
---|---|
Provider Name | Mr. Podduturu Sridhar Reddy |
First Address | Port Huron, MI 48060 |
Second Address | Port Huron, MI 48060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4153017 | (05) | MI |
F84203 | (02) |