Provider Demographics
NPI:1114044468
Name:ISKAPALLI, SRINIVASA R (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASA
Middle Name:R
Last Name:ISKAPALLI
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 1:1800 BUCKNER ST STE C120
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4453
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-425-3793
Practice Address - Street 1:1800 BUCKNER ST STE C120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4453
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-425-3793
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT183379207R00000X
LA207816207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine