Provider Demographics
NPI:1629165378
Name:KAMATH, SREENIVAS P (MD)
Entity Type:Individual
Prefix:
First Name:SREENIVAS
Middle Name:P
Last Name:KAMATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1855 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4853
Mailing Address - Country:US
Mailing Address - Phone:574-533-7476
Mailing Address - Fax:574-533-7145
Practice Address - Street 1:1855 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4853
Practice Address - Country:US
Practice Address - Phone:574-533-7476
Practice Address - Fax:574-533-7145
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01064505A207RC0000X, 207RC0000X
MI4301091323207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG98994Medicare UPIN