Provider Demographics
NPI:1578664116
Name:CHERLO, SREENIVASULU (MD)
Entity Type:Individual
Prefix:
First Name:SREENIVASULU
Middle Name:
Last Name:CHERLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SREENIVASULA
Other - Middle Name:
Other - Last Name:CHERLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:211 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4503
Mailing Address - Country:US
Mailing Address - Phone:281-592-8622
Mailing Address - Fax:281-592-8699
Practice Address - Street 1:211 S. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4503
Practice Address - Country:US
Practice Address - Phone:281-592-8622
Practice Address - Fax:281-592-8699
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111766506Medicaid
TXK1393OtherMEDICAL LICENSE
TX8A6198Medicare PIN
TXG36656Medicare UPIN