Provider Demographics
NPI:1902842172
Name:YEDLAPALLI, SRI VENKATESWARA CH (MD)
Entity Type:Individual
Prefix:
First Name:SRI
Middle Name:VENKATESWARA CH
Last Name:YEDLAPALLI
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 1:3520 PRESTON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9487
Mailing Address - Country:US
Mailing Address - Phone:214-843-4623
Mailing Address - Fax:214-436-5792
Practice Address - Street 1:3520 PRESTON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9487
Practice Address - Country:US
Practice Address - Phone:214-843-4623
Practice Address - Fax:214-436-5792
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18470208M00000X
TXN4861207P00000X, 207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07559846Medicaid
MSI18623Medicare UPIN
MS07559846Medicaid
TX8ED699Medicare PIN
TX8ED697Medicare PIN
TX8ED701Medicare PIN
MS930003028Medicare ID - Type Unspecified
TXTXB148160Medicare PIN
TX8ED700Medicare PIN