Provider Demographics
NPI:1265494447
Name:PISATI, SRILAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRILAKSHMI
Middle Name:
Last Name:PISATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5726
Mailing Address - Country:US
Mailing Address - Phone:513-481-9100
Mailing Address - Fax:513-389-7052
Practice Address - Street 1:3502 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5726
Practice Address - Country:US
Practice Address - Phone:513-481-9100
Practice Address - Fax:513-389-7052
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010629172027OtherCARESOURCE
OH0403903OtherUNITED HEALTHCARE
OH2043345Medicaid
OH7370605OtherCHOICECARE / HUMANA
OH0094088OtherEMERALD HEALTH NETWORK
OH010629172027OtherCARESOURCE
OHG68023Medicare UPIN