Individual
SREYA TALASILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3190 LANCER ST, PORTAGE, IN 46368-4488
(219) 764-3600
Mailing address
3190 LANCER ST, PORTAGE, IN 46368-4488
(219) 764-3600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036.146276
IL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
01085876A
IN
Other
Enumeration date
04/01/2014
Last updated
07/25/2021
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