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NPI Code Detail

MEDICARE: SRIDHAR JATLA MD

MEDICARE: SRIDHAR JATLA MD
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
12084P0800XPsychiatry Physician01063214AIN
22084S0012XSleep Medicine (Psychiatry & Neurology) Physician01063214AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891704565
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRIDHAR JATLA MD
Provider Business Mailing Address
First Line : 6983 HILLSDALE CT
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2054
Country : US
Telephone Number : 317-849-8350
Fax Number : 317-576-6311
Provider Business Practice Location Address
First Line : 2330 S DIXON RD STE 325
Second Line :
City : KOKOMO
State : IN
Zip : 46902-6430
Country : US
Telephone Number : 765-455-8822
Fax Number : 765-865-3935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 02/27/2025

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Directions to “ SRIDHAR JATLA MD” Practice Location

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