Provider Demographics
NPI:1710909478
Name:ST CLAIR PULMONARY & CRITICAL CARE P C
Entity Type:Organization
Organization Name:ST CLAIR PULMONARY & CRITICAL CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PODDUTURU
Authorized Official - Middle Name:SRIDHAR
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:810-990-8222
Mailing Address - Street 1:2615 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6575
Mailing Address - Country:US
Mailing Address - Phone:810-990-8222
Mailing Address - Fax:810-937-5592
Practice Address - Street 1:2615 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6575
Practice Address - Country:US
Practice Address - Phone:810-990-8222
Practice Address - Fax:810-937-5592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM92910Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER