Provider Demographics
NPI:1881603389
Name:MURTHY, SREENIVASA (MD)
Entity type:Individual
Prefix:DR
First Name:SREENIVASA
Middle Name:
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3911
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3911
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053973OtherMCLAREN HEALTH ADVANTAGE
MI1053973OtherMCLAREN HEALTH PLAN-COMMERCIAL
MIP00809516OtherRAILROAD MEDICARE
MI0802310541OtherBLUE CROSS BLUE SHIELD
MI0802310541OtherBLUE CARE NETWORK
MI200000022164OtherPHP FAMILYCARE
MI0M21440074OtherMEDICARE ADVANTAGE
MI7932749OtherAETNA
MI200000022164OtherPHP
MI1053973OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000022164OtherPHP
MI1053973OtherMCLAREN HEALTH PLAN-MEDICAID