Provider Demographics
NPI:1184697385
Name:SOMISETTY, SREEDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SREEDHAR
Middle Name:
Last Name:SOMISETTY
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 1:410 N 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2495
Mailing Address - Country:US
Mailing Address - Phone:641-672-3360
Mailing Address - Fax:641-672-3366
Practice Address - Street 1:410 N 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2495
Practice Address - Country:US
Practice Address - Phone:641-672-3360
Practice Address - Fax:641-672-3366
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35032207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34844OtherBLUE CROSS/BLUE SHIELD
IA0291344Medicaid
IAIA0123OtherJOHN DEERE PROVIDE NUMBER
I10307OtherMEDICARE GROUP NUMBER
IAIA0123OtherJOHN DEERE PROVIDE NUMBER