James Sirajuddin MD PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4301039518 Issued in MI

Legal business name

JAMES SIRAJUDDIN MD PC

Doing business as

Riverside Medical Clinic

Practice address

203 Center St
South Haven, MI 49090-1311

Phone

(269) 637-2102

Fax

(269) 637-3783

NPI assigned

Oct 18, 2007

Last updated

Apr 1, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Sirajuddin, M.D.

Title

President

Phone

(269) 637-2102

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverside Medical Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1609065358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 CENTER ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901311",
            "telephone_number": "269-637-2102",
            "fax_number": "269-637-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CENTER ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901311",
            "telephone_number": "269-637-2102",
            "fax_number": "269-637-3783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES SIRAJUDDIN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "SIRAJUDDIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-637-2102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301039518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2111690",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Physician in South Haven, MI
• Providers in South Haven, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.