Provider Demographics
NPI:1174503221
Name:DANDAMUDI, SESHAGIRI (MD)
Entity Type:Individual
Prefix:DR
First Name:SESHAGIRI
Middle Name:
Last Name:DANDAMUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 COLLEGE ST.
Mailing Address - Street 2:SUITE D
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2331
Mailing Address - Country:US
Mailing Address - Phone:269-969-8920
Mailing Address - Fax:269-224-6138
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3461
Practice Address - Country:US
Practice Address - Phone:269-968-3030
Practice Address - Fax:269-968-2103
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD040021207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101391024Medicaid
MIP14130002Medicare ID - Type Unspecified
MI101391024Medicaid