Provider Demographics
NPI:1831197581
Name:THOUTREDDY, SHALINI (MD)
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:THOUTREDDY
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 1:1295 BARRY DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1369
Mailing Address - Country:US
Mailing Address - Phone:810-667-4994
Mailing Address - Fax:
Practice Address - Street 1:1295 BARRY DR STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1369
Practice Address - Country:US
Practice Address - Phone:810-667-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080565207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000026973OtherPHYSICIANS HEALTH PLAN
MI1103307661OtherBLUE CROSS BLUE SHIELD OF MICHIGAN/BLUE CARE NETWORK
MI7470740OtherAETNA
MI7470740OtherAETNA
F36477110Medicare PIN
MI4753047/10Medicaid
MI7470740OtherAETNA