MEDICARE: SRAVANI AVULA

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	125067278	IL
2	207RC0000X	Cardiovascular Disease Physician	T0709	TX

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	:	1215311741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRAVANI AVULA

Provider Business Mailing Address
First Line	:	430 W SUNSET RD STE 115
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1770
Country	:	US
Telephone Number	:	210-640-1646
Fax Number	:	210-640-1647

Provider Business Practice Location Address
First Line	:	430 W SUNSET RD STE 115
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1770
Country	:	US
Telephone Number	:	210-640-1646
Fax Number	:	210-640-1647

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	01/04/2024

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Directions to “ SRAVANI AVULA ” Practice Location

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