Provider Demographics
NPI:1659328508
Name:VADDINENI, SARAT KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAT
Middle Name:KUMAR
Last Name:VADDINENI
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 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-283
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-7696
Mailing Address - Fax:269-349-0610
Practice Address - Street 1:601 JOHN STREET
Practice Address - Street 2:SUITE M-283
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-349-7696
Practice Address - Fax:269-349-0610
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010835942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0203912341OtherBCBS
MI1417961137OtherBCBSM - BMH
MI1417961137OtherBCBS (BRONSON)
MI487650110Medicaid
MI1659328508Medicaid
MIG10750Medicare UPIN
MI1417961137OtherBCBSM - BMH
MI1417961137OtherBCBS (BRONSON)
MI0M37330007Medicare PIN
MI1659328508Medicaid