MEDICARE: DR. SRINATH TRIPURANENI MD

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	328456	LA
2	207R00000X	Internal Medicine Physician	E-18565	AR

General Provider Information

NPI Number	:	1588154900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINATH TRIPURANENI MD

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-274-4300
Fax Number	:	314-364-6321

Provider Business Practice Location Address
First Line	:	7303 ROGERS AVE STE 200
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4112
Country	:	US
Telephone Number	:	479-274-4300
Fax Number	:	479-274-4399

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	10/18/2024

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