Provider Demographics
NPI:1750011185
Name:MADIDI, SAMEER (MD)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:MADIDI
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 1:1530 N 7TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1061
Mailing Address - Country:US
Mailing Address - Phone:812-238-7631
Mailing Address - Fax:
Practice Address - Street 1:1530 N 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1061
Practice Address - Country:US
Practice Address - Phone:812-238-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11022371A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program