Provider Demographics
NPI:1639138290
Name:KOLLI, RADHIKA A (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:A
Last Name:KOLLI
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:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1728
Mailing Address - Country:US
Mailing Address - Phone:817-851-9426
Mailing Address - Fax:
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-472-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7295207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200405200Medicaid
TX272663YT95Medicare PIN
IN200405200Medicaid
IN499500 BBBMedicare PIN