Provider Demographics
NPI:1932148178
Name:GADDINI, MICHAEL SALVADORE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SALVADORE
Last Name:GADDINI
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 1:2019 OUTRIGGER DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3756
Mailing Address - Country:US
Mailing Address - Phone:916-835-5892
Mailing Address - Fax:
Practice Address - Street 1:2019 OUTRIGGER DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3756
Practice Address - Country:US
Practice Address - Phone:916-835-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52746207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G527460Medicaid
CAA52337Medicare UPIN
CA00G527460Medicaid
CA00G527460Medicare PIN