Provider Demographics
NPI:1093831687
Name:BANDI, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:BANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:2923 GINNALA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2702
Practice Address - Country:US
Practice Address - Phone:970-669-6660
Practice Address - Fax:970-663-0721
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-063582084N0400X
CO482812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22008764Medicaid
CO22008764Medicaid