Individual
SURENDRA KOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9185
Mailing address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9185
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
04-37597
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A122586
MEDICAL LICENSE NUMBER
CA
Enumeration date
06/17/2009
Last updated
07/07/2015
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