Provider Demographics
NPI:1174586267
Name:SRIPADA, SIVA KUMAR (DO)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:KUMAR
Last Name:SRIPADA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 S SAGINAW ST STE 1815
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2677
Mailing Address - Country:US
Mailing Address - Phone:810-275-9152
Mailing Address - Fax:810-213-0228
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:SUITE 1815
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2677
Practice Address - Country:US
Practice Address - Phone:810-275-9152
Practice Address - Fax:810-213-0228
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016685207LP2900X, 2081P2900X, 208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI556314344OtherBLUE CROSS BLUE SHIELD
MI4828649-11Medicaid
MI4828658-11Medicaid
MI4828658-11Medicaid
MIN29240007Medicare ID - Type Unspecified