Provider Demographics
NPI:1912439209
Name:POKALA, SRIDEVI KUSUMA KUMARI (MD)
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:KUSUMA KUMARI
Last Name:POKALA
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 1:12631 E 17TH AVE # MSB158
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2527
Mailing Address - Country:US
Mailing Address - Phone:303-724-1097
Mailing Address - Fax:303-724-1891
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:303-724-1097
Practice Address - Fax:303-724-1891
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
COTL.0008070OtherCOLORADO MEDICAL LICENSE