Provider Demographics
NPI:1023126448
Name:YADAM, SUBRAMANYAM (MD)
Entity type:Individual
Prefix:DR
First Name:SUBRAMANYAM
Middle Name:
Last Name:YADAM
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 1:4201 CAMPUS RIDGEDRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-488-5450
Mailing Address - Fax:989-488-5455
Practice Address - Street 1:4201 CAMPUS RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-488-5450
Practice Address - Fax:989-488-5455
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISY038909207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2905610541OtherBLUE CROSS BLUE SHIELD
MI2120984Medicaid
A76207Medicare UPIN
MI2120984Medicaid