Sudha R Damidi, M.D.
Individual provider Active NPI Pediatrics Physician · Pigeon, MI
NPI 1407902869 · NPPES record last updated Jun 16, 2023
Key facts
- NPI
- 1407902869
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4301089171 (MI)
- Practice address
- 168 N Caseville Rd
Pigeon, MI 48755-9415 - Phone
- (989) 453-2141
- Fax
- (989) 453-2559
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220110001152 | MI | Practitioner - Pediatric Medicine | 6709278443 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301089171 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health System | Current |
Accepting new patients | |
| Henry Ford Health System | Pediatrics | Current |
Accepting new patients |
| Henry Ford Health System | Current | Accepting new patients | |
| Scheurer Hospital | Past | Accepting new patients | |
| Northpointe Pediatrics PC | Past | Accepting new patients | |
| Northpointe Pediatrics, P.C. | Pediatrics | Past | Accepting new patients |
| Flint Children'S Center, PC | Pediatrics | Past | Accepting new patients |
| Scheurer Hospital | Past | Accepting new patients |
Locations
1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953
2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062
131 Kercheval Ave
Grosse Pointe Farms, MI 48236
Phone (313) 640-1000
Interoperability endpoints
- sdamidi147284@direct.covenanthealthcare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301089171 | MI | Yes |
Addresses
Primary practice location
168 N Caseville Rd
Pigeon, MI 48755-9415
Mailing address
168 N Caseville Rd
Pigeon, MI 48755-9415
Phone (989) 453-2141
Other providers in Pigeon, MI
- Jane Ballard
- Lois Booms
- Karen Buck
- Douglas Arthur Buehler
- Liberty Hope Cloutier
- Sheena Lynn Damm
- Julia Elaine Deer
- Barbara Lynn Doran
- Jesika Ferris-Struve
- Sity Milad Girgis
All providers in Pigeon, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.