Provider Demographics
NPI:1629176698
Name:PAIDIPATY, KAMALA SUDHA (MD)
Entity Type:Individual
Prefix:
First Name:KAMALA
Middle Name:SUDHA
Last Name:PAIDIPATY
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 1:1525 W CARO RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9686
Mailing Address - Country:US
Mailing Address - Phone:989-672-2100
Mailing Address - Fax:
Practice Address - Street 1:6320 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-9603
Practice Address - Country:US
Practice Address - Phone:989-872-8070
Practice Address - Fax:989-872-5734
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76492Medicare UPIN