Provider Demographics
NPI:1538489810
Name:UPPALAPATI, SRI VENKATA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SRI VENKATA
Middle Name:
Last Name:UPPALAPATI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:
Practice Address - Street 1:255 LEBANON RD
Practice Address - Street 2:SUITE 124
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036
Practice Address - Country:US
Practice Address - Phone:918-852-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011051922084P0800X, 390200000X
KS94-07412390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538489810Medicaid