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NPI Code Detail

MEDICARE: SRISAI P C

MEDICARE: SRISAI P C
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
1207R00000XInternal Medicine Physician01046950IN

General Provider Information

NPI Number : 1609019900
Entity Type Code : Organization
Provider Name (Legal Business Name) : SRISAI P C
Provider Business Mailing Address
First Line : 7972 WEST JEFFERSON BLVD
Second Line : SUITE A
City : FORT WAYNE
State : IN
Zip : 46804-4140
Country : US
Telephone Number : 260-459-1780
Fax Number : 260-459-2779
Provider Business Practice Location Address
First Line : 7972 WEST JEFFERSON BLVD
Second Line : SUITE A
City : FORT WAYNE
State : IN
Zip : 46804-4140
Country : US
Telephone Number : 260-459-1780
Fax Number : 260-459-2779
Authorized Official
Title or Position : OWNER
Name : ANURADHA KOLLIPARA
Credential : M.D.
Telephone Number : 260-459-1780
Provider Enumeration Date : 04/16/2009
Last Update Date : 03/30/2017

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Directions to “SRISAI P C ” Practice Location

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