Individual
SIREESHA VUTUKURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5927
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5927
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
320512
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2016
Last updated
06/28/2023
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