Provider Demographics
NPI:1386609444
Name:SADASIVAN, NANJAPPA C (MD)
Entity type:Individual
Prefix:
First Name:NANJAPPA
Middle Name:C
Last Name:SADASIVAN
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:PO BOX 1108
Mailing Address - Street 2:ATTN: BARB SIMMONS
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1108
Mailing Address - Country:US
Mailing Address - Phone:734-677-7400
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:2333 BIDDLE AVENUE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-677-7400
Practice Address - Fax:734-677-7407
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010336332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3009503251OtherBCBS OF MI
MIB45247OtherHEALTH ALLIANCE PLAN NBR
MI0996742OtherHEALTHPLUS
MI119545OtherSELECTCARE
MI1680573Medicaid
MI3009503251OtherBCN OF MI
MIP00060426OtherRR MEDICARE PIN
MI11293247OtherCAQH
MI321192OtherULTIMED ID NBR
MI3009503251OtherBCN OF MI
MI1822828Medicare PIN