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NPI Code Detail

MEDICARE: SRINIVAS RAO DURSHANAPALLI

MEDICARE: SRINIVAS RAO DURSHANAPALLI
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
1122300000XDentist019028802IL

General Provider Information

NPI Number : 1710265434
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRINIVAS RAO DURSHANAPALLI
Provider Business Mailing Address
First Line : 2902 W LAKE TRAIL CT
Second Line :
City : DUNLAP
State : IL
Zip : 61525-7546
Country : US
Telephone Number : 203-215-4687
Fax Number :
Provider Business Practice Location Address
First Line : 5470 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1620
Country : US
Telephone Number : 317-643-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2011
Last Update Date : 12/31/2025

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Directions to “ SRINIVAS RAO DURSHANAPALLI ” Practice Location

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