Provider Demographics
NPI:1790096543
Name:KOLLURI, SANGEETHA LAKSHMI (DO)
Entity Type:Individual
Prefix:DR
First Name:SANGEETHA
Middle Name:LAKSHMI
Last Name:KOLLURI
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4613 BEE CAVES RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5206
Mailing Address - Country:US
Mailing Address - Phone:512-862-1881
Mailing Address - Fax:512-862-2433
Practice Address - Street 1:4613 BEE CAVES RD STE 102
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5206
Practice Address - Country:US
Practice Address - Phone:512-862-1881
Practice Address - Fax:512-862-2433
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ56822086X0206X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360601401Medicaid
TX512903YKYCMedicare PIN