Provider Demographics
NPI:1003137126
Name:SREEDASYAM, MAHESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:KUMAR
Last Name:SREEDASYAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:995 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5588
Mailing Address - Country:US
Mailing Address - Phone:812-353-3060
Mailing Address - Fax:812-353-3070
Practice Address - Street 1:995 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-353-3060
Practice Address - Fax:812-353-3070
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2020-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN11015332A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine