Provider Demographics
NPI:1669907440
Name:THAMBULURU, SIRISHA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SIRISHA REDDY
Middle Name:
Last Name:THAMBULURU
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 1:9220 ELLERBE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6709
Mailing Address - Country:US
Mailing Address - Phone:318-681-5282
Mailing Address - Fax:318-681-5284
Practice Address - Street 1:9220 ELLERBE RD STE 700
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6709
Practice Address - Country:US
Practice Address - Phone:318-681-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478559207RE0101X
LA342995207RE0101X, 207RE0101X
AL37934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine