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General NPI Number Information
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NPI Number | 1275898280
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Entity Type | Individual
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Provider Name | SUVARNA KOLLURI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 9509 N BEACH ST STE 102
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City | FORT WORTH
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State | TX
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Zip | 76244-6399
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Country | US
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Telephone | 817-617-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 809 GLEN ABBEY DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1314
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Country | US
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Telephone | 908-249-3487
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | Q0088
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 46281
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License Number State | AZ
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