Provider Demographics
NPI:1942658653
Name:NETRAVALI, ILKA (MD)
Entity Type:Individual
Prefix:
First Name:ILKA
Middle Name:
Last Name:NETRAVALI
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 1:1325 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3141
Mailing Address - Country:US
Mailing Address - Phone:817-421-3376
Mailing Address - Fax:817-416-4269
Practice Address - Street 1:1325 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3141
Practice Address - Country:US
Practice Address - Phone:817-421-3376
Practice Address - Fax:817-416-4269
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8898207NP0225X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology