Provider Demographics
NPI:1295783736
Name:POTLURI, SRINIVASA P (MD)
Entity type:Individual
Prefix:
First Name:SRINIVASA
Middle Name:P
Last Name:POTLURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6601 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2502
Mailing Address - Country:US
Mailing Address - Phone:469-326-3400
Mailing Address - Fax:469-326-3499
Practice Address - Street 1:6601 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2502
Practice Address - Country:US
Practice Address - Phone:469-326-3400
Practice Address - Fax:469-326-3499
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY207RC0000X
TXM3698207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01166639OtherRAILROAD MEDICARE