MEDICARE: DR. SRILAKSHMI PISATI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-073706	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010629172027	OTHER	OH	CARESOURCE
2	0403903	OTHER	OH	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7370605	OTHER	OH	CHOICECARE / HUMANA
5	0094088	OTHER	OH	EMERALD HEALTH NETWORK

General Provider Information

NPI Number	:	1265494447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRILAKSHMI PISATI M.D.

Provider Business Mailing Address
First Line	:	3502 BOUDINOT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-5726
Country	:	US
Telephone Number	:	513-481-9100
Fax Number	:	513-389-7052

Provider Business Practice Location Address
First Line	:	3502 BOUDINOT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-5726
Country	:	US
Telephone Number	:	513-481-9100
Fax Number	:	513-389-7052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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