Individual
DR. SREENIVAS GUDIMETLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J2041
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060057347
RAILROAD MEDICARE PROV NO
TX
05
—
125365003
—
TX
01
—
193006902
UNITED HEALTHCARE PROV NO
TX
01
—
2749061002
CIGNA PROVIDER NUMBER
TX
01
—
5673038
AETNA PROVIDER NUMBER
TX
01
—
89755J
BCBS PROVIDER NUMBER
TX
01
—
89790V
BLUE CROSS
TX
01
—
P00074958
RAIL ROAD MEDICARE
—
Enumeration date
06/20/2005
Last updated
04/08/2008
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