Provider Demographics
NPI:1851551741
Name:GUDISEVA, SREEVANI (MD, FHM)
Entity Type:Individual
Prefix:DR
First Name:SREEVANI
Middle Name:
Last Name:GUDISEVA
Suffix:
Gender:F
Credentials:MD, FHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ANCHOR TER
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5465
Mailing Address - Country:US
Mailing Address - Phone:469-265-6604
Mailing Address - Fax:
Practice Address - Street 1:1100 ANCHOR TER
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5465
Practice Address - Country:US
Practice Address - Phone:469-265-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7095207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine