Provider Demographics
NPI:1063494607
Name:CHALASANI, SRIDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:
Last Name:CHALASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3770 CAPITAL AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9411
Mailing Address - Country:US
Mailing Address - Phone:269-441-1771
Mailing Address - Fax:269-441-1773
Practice Address - Street 1:3770 CAPITAL AVE SW
Practice Address - Street 2:STE A
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9411
Practice Address - Country:US
Practice Address - Phone:269-441-1771
Practice Address - Fax:269-441-1773
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MISC077498208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
134398OtherPREFERRED CHOICES
135082OtherGREAT LAKES
383125785105OtherCOMMUNITY CHOICE MICHIGAN
MI4408297Medicaid
MI1417961137OtherBCBS BRONSON
1430026OtherPHYSICIANS HEALTH PLAN
280001089OtherRAILROAD MEDICARE
7512375OtherAETNA
P116414OtherBLUE CARE NETWORK
MI1063494607Medicaid
0105542OtherCIGNA
0105542OtherCIGNA
7512375OtherAETNA
MI1417961137OtherBCBS BRONSON