Individual
SHRAVAN KUMAR REDDY GANGULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 688-6566
(620) 688-6577
Mailing address
8337 E 81ST ST APT 1237, TULSA, OK 74133-8088
(615) 415-5392
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0436385
KS
207Q00000X
Family Medicine Physician
27717
OK
Other
Enumeration date
07/31/2010
Last updated
12/15/2017
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