Provider Demographics
NPI:1821301367
Name:VULAVA, SRIKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKRISHNA
Middle Name:
Last Name:VULAVA
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 1:5200 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8909
Practice Address - Country:US
Practice Address - Phone:812-934-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134046207R00000X
MO2019008706207R00000X
WAMD61465449207R00000X
NV18184207R00000X
NMMD2022-0340207R00000X
OH35.120524207R00000X
IN01083185A207R00000X, 208M00000X
MN71052207R00000X
COCDR.0003676207R00000X
SC86614207R00000X
ORMD213137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086353Medicaid
NMMD2022-0340OtherNEW MEXICO MEDICAL BOARD