Provider Demographics
NPI:1407951569
Name:GUDIPATI, SUHASINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHASINI
Middle Name:
Last Name:GUDIPATI
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 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:989-583-6915
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6800
Practice Address - Fax:989-583-6915
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058835207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0735678OtherBCBSM PIN
MI1407951569Medicaid
MI101100OtherGREAT LAKES HEALTH PLAN
MI381870664OtherTAX ID
MA110067822OtherRAILROAD MEDICARE
MI4G07356781OtherHEALTHPLUS OF MICHIGAN
MI700G360210OtherBCBSM
MISG058835OtherLICENSE
MIF34991Medicare UPIN
MISG058835OtherLICENSE