Individual
SRINIVAS KOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-1000
(715) 393-1469
Mailing address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-1000
(715) 393-1469
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01063060A
IN
2086S0129X
Vascular Surgery Physician
036132466
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
036132466
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
71626
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235100397
—
WI
Enumeration date
01/27/2006
Last updated
12/21/2021
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