MEDICARE: SRIDHAR JATLA 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	2084P0800X	Psychiatry Physician	01063214A	IN
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	01063214A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891704565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRIDHAR JATLA MD

Provider Business Mailing Address
First Line	:	6983 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2054
Country	:	US
Telephone Number	:	317-849-8350
Fax Number	:	317-576-6311

Provider Business Practice Location Address
First Line	:	2330 S DIXON RD STE 325
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-6430
Country	:	US
Telephone Number	:	765-455-8822
Fax Number	:	765-865-3935

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/27/2025

Similar Medicare Providers

1396832556 — JOSEPHSON-WALLACK-MUNSHOWER NEUROLOGY PC
Practice Location Address:

2330 S DIXON RD STE 325
KOKOMO, IN
46902-6430

Practice Phone: 317-308-2800
Practice Fax: 765-865-3935

1902070089 — KRISTYN J TEKULVE MD
Practice Location Address:

2330 S DIXON RD STE 325
KOKOMO, IN
46902-6430

Practice Phone: 765-455-8822
Practice Fax: 765-865-3935

1245681204 — MRS. HAILEY ROCHELLE GUIDI MA, BCBA
Practice Location Address:

2330 S DIXON RD STE 350
KOKOMO, IN
46902-6430

Practice Phone: 765-632-0621
Practice Fax:

1821704362 — AMBER VISSER
Practice Location Address:

2330 S DIXON RD STE 350
KOKOMO, IN
46902-6430

Practice Phone: 765-789-2564
Practice Fax: 765-448-1864

1588448781 — BRIELLE NOLLEY
Practice Location Address:

2330 S DIXON RD STE 350
KOKOMO, IN
46902-6430

Practice Phone: 765-789-0564
Practice Fax:

1871374983 — HUNTER STEPHENS RBT
Practice Location Address:

2330 S DIXON RD STE 350
KOKOMO, IN
46902-6430

Practice Phone: 765-789-2564
Practice Fax:

Directions to “ SRIDHAR JATLA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.