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General NPI Number Information
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NPI Number | 1235100397
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Entity Type | Individual
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Provider Name | SRINIVAS KOLLA MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 3400 MINISTRY PKWY
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City | WESTON
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State | WI
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Zip | 54476-5220
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Country | US
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Telephone | 715-393-1000
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Fax | 715-393-1469
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Provider Business Mailing Address
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Address Line | 3400 MINISTRY PKWY
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City | WESTON
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State | WI
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Zip | 54476-5220
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Country | US
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Telephone | 715-393-1000
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Fax | 715-393-1469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01063060A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036132466
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036132466
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 71626
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License Number State | WI
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