MEDICARE: SRILATHA VELLANKI 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	L8995	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8M5981	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1952346579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRILATHA VELLANKI MD

Provider Business Mailing Address
First Line	:	6901 SNIDER PLZ
Second Line	:	SUITE 130
City	:	DALLAS
State	:	TX
Zip	:	75205-5648
Country	:	US
Telephone Number	:	972-381-6690
Fax Number	:	214-361-2552

Provider Business Practice Location Address
First Line	:	6901 SNIDER PLZ
Second Line	:	SUITE 130
City	:	DALLAS
State	:	TX
Zip	:	75205-5648
Country	:	US
Telephone Number	:	972-381-6690
Fax Number	:	214-361-2552

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	11/28/2007

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Directions to “ SRILATHA VELLANKI MD” Practice Location

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