Provider Demographics
NPI:1558649988
Name:KOLLI, SREE HARI PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SREE
Middle Name:HARI PRAVEEN
Last Name:KOLLI
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 1:23351 CHAGRIN BLVD
Mailing Address - Street 2:210 NORTH DEVILLE APPARTMENTS
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5527
Mailing Address - Country:US
Mailing Address - Phone:216-926-0374
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH127749207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1558649988Medicaid
OH1558649988Medicare UPIN
OH1558649988Medicare PIN
OH1558649988Medicare Oscar/Certification
OH1558649988Medicaid