Provider Demographics
NPI:1124019450
Name:CHEBROLU, SRIVASA B (MD)
Entity Type:Individual
Prefix:
First Name:SRIVASA
Middle Name:B
Last Name:CHEBROLU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3315 COLORADO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6884
Mailing Address - Country:US
Mailing Address - Phone:940-320-1708
Mailing Address - Fax:940-565-5457
Practice Address - Street 1:4401 COIT RD
Practice Address - Street 2:SUITE 303
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0500
Practice Address - Country:US
Practice Address - Phone:469-574-0464
Practice Address - Fax:469-574-0471
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-12-17
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Provider Licenses
StateLicense IDTaxonomies
TXM1050207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00239743OtherRR MEDICARE
TX173507801Medicaid
TX173507801Medicaid