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Individual

DR. SRINIVAS REDDY PULI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
1575 S MAIN ST, FORT WORTH, TX 76104
(817) 702-3431
(817) 927-3603
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801-2529

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0430736
KS
207R00000X
Internal Medicine Physician
2006012209
MO
207RG0100X
Gastroenterology Physician
Primary
036-115481
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
809840
MEDICARE GROUP PTAN
IL
01
809840049
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
07/21/2006
Last updated
05/14/2021
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