Provider Demographics
NPI:1770588279
Name:JANARDAN, SRINIVAS K (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:K
Last Name:JANARDAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 LAFAYETTE AVE SE
Mailing Address - Street 2:STE 400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-752-6525
Mailing Address - Fax:616-752-6556
Practice Address - Street 1:310 LAFAYETTE AVE SE
Practice Address - Street 2:STE 400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-752-6525
Practice Address - Fax:616-752-6556
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060361174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3256628Medicaid
MIE19639Medicare UPIN
MI3256628Medicaid