Provider Demographics
NPI:1881631356
Name:THATIKONDA, SRIVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIVANI
Middle Name:
Last Name:THATIKONDA
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:805 W 37TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1171
Practice Address - Country:US
Practice Address - Phone:512-421-4280
Practice Address - Fax:512-454-4575
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31575207R00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215453601Medicaid
TXP00911449OtherRAILROAD MEDICARE
TX215453602Medicaid
TX215453602Medicaid
TXTXB107565Medicare PIN