Provider Demographics
NPI:1386645299
Name:BADDIGAM, BASIVI REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIVI
Middle Name:REDDY
Last Name:BADDIGAM
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:PO BOX 7002
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-7002
Mailing Address - Country:US
Mailing Address - Phone:586-466-9718
Mailing Address - Fax:586-466-9961
Practice Address - Street 1:43211 DALCOMA DR
Practice Address - Street 2:STE. 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6309
Practice Address - Country:US
Practice Address - Phone:586-263-6812
Practice Address - Fax:586-263-6835
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010536792084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082559OtherAETNA
1536832OtherUBH
MI138868OtherCARECHOICES
MI045965OtherVALUEOPTIONS
MI2605021781OtherBCBSM
MI0501753OtherBCBSM
MI4769047-10Medicaid
MI819269000OtherMAGELLAN
MIF46966OtherHAP
0P22030001Medicare PIN
MI819269000OtherMAGELLAN
0829521Medicare PIN