Provider Demographics
NPI:1609019900
Name:SRISAI P C
Entity Type:Organization
Organization Name:SRISAI P C
Other - Org Name:ANURADHA KOLLIPARA, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLIPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-459-1780
Mailing Address - Street 1:7972 WEST JEFFERSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4140
Mailing Address - Country:US
Mailing Address - Phone:260-459-1780
Mailing Address - Fax:260-459-2779
Practice Address - Street 1:7972 WEST JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-459-1780
Practice Address - Fax:260-459-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty