Provider Demographics
NPI:1891905196
Name:HIREMATH, INDUDHAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:INDUDHAR
Middle Name:S
Last Name:HIREMATH
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 1:4618 GRAND PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1348
Mailing Address - Country:US
Mailing Address - Phone:269-344-9049
Mailing Address - Fax:
Practice Address - Street 1:4618 GRAND PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-1348
Practice Address - Country:US
Practice Address - Phone:269-344-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032578208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74116Medicare UPIN