Healthcare Provider Details

I. General information

NPI: 1851713879
Provider Name (Legal Business Name): SRAVAN KUMAR METLA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W RAHN RD
DAYTON OH
45429-2219
US

IV. Provider business mailing address

160 CANNONBURY CT APT 1
KETTERING OH
45429-8110
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-8990
  • Fax:
Mailing address:
  • Phone: 347-255-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.123313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: