Individual
SUNIL C KOLLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MEDICAL PKWY STE A, LAKEWAY, TX 78738-5621
(512) 571-5000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036110816
IL
208M00000X
Hospitalist Physician
Primary
N0900
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036110816
BCBS
IL
05
—
036110816
—
IL
01
—
341646YMVU
WELLMED NETWORKS INC
TX
01
—
P00301909
RAIL ROAD MEDICARE
IL
Enumeration date
03/22/2006
Last updated
01/26/2022
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