Provider Demographics
NPI:1952302861
Name:BADDIGAM, PRAMEELA DEVI (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:PRAMEELA
Middle Name:DEVI
Last Name:BADDIGAM
Suffix:
Gender:F
Credentials:MD MBA
Other - Prefix:MISS
Other - First Name:PRAMEELA
Other - Middle Name:DEVI
Other - Last Name:MADIREDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7002
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-7002
Mailing Address - Country:US
Mailing Address - Phone:586-263-6812
Mailing Address - Fax:586-263-6835
Practice Address - Street 1:43211 DALCOMA DR
Practice Address - Street 2:STE. 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6309
Practice Address - Country:US
Practice Address - Phone:586-263-6812
Practice Address - Fax:586-263-6835
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010553882084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2204444OtherCIGNA
819269000OtherMAGELLAN
MIF63502OtherHAP
1554633OtherUBH
MI2605021771OtherBCBSM
540532OtherVALUEOPTIONS
MIP35210FOtherBCN
MI0501738OtherBCBSM
1082559OtherAETNA
140176OtherCARECHOICES
MI4769056-10Medicaid
MIP35210FOtherBCN