Provider Demographics
NPI:1013710623
Name:SIDDADA, SRUTHI (MD)
Entity type:Individual
Prefix:
First Name:SRUTHI
Middle Name:
Last Name:SIDDADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15855 19 MILE RD, CLINTON TOWNSHIP
Mailing Address - Street 2:
Mailing Address - City:MACOMB COUNTY
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:313-916-1601
Mailing Address - Fax:
Practice Address - Street 1:15855 19 MILE RD.
Practice Address - Street 2:CLINTON TOWNSHIP
Practice Address - City:MACOMB COUNTY
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:313-916-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program