Basic Information
| Provider Information | |||||||||
| NPI: | 1750011185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADIDI | ||||||||
| FirstName: | SAMEER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122387631 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1530 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122387631 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2022 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 11022371A | IN | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.