Provider Demographics
NPI:1932903341
Name:SRIDASYAM, KARTHIK (MD)
Entity type:Individual
Prefix:
First Name:KARTHIK
Middle Name:
Last Name:SRIDASYAM
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 1:7637 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2808
Mailing Address - Country:US
Mailing Address - Phone:248-385-7141
Mailing Address - Fax:
Practice Address - Street 1:332 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:COLOMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-788-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program