Provider Demographics
NPI:1407902869
Name:DAMIDI, SUDHA R (MD)
Entity Type:Individual
Prefix:
First Name:SUDHA
Middle Name:R
Last Name:DAMIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9415
Mailing Address - Country:US
Mailing Address - Phone:989-453-2141
Mailing Address - Fax:989-453-2559
Practice Address - Street 1:168 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9415
Practice Address - Country:US
Practice Address - Phone:989-453-2141
Practice Address - Fax:989-453-2559
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301089171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics