Individual
KISHORE K SRIRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
850 N HARRISON ST, WARSAW, IN 46580-3163
(574) 267-7169
(574) 269-3995
Mailing address
850 N HARRISON ST, WARSAW, IN 46580-3163
(574) 267-7169
(574) 269-0597
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01070060A
IN
390200000X
Student in an Organized Health Care Education/Training Program
2007016061
MO
Other
Enumeration date
08/13/2007
Last updated
08/29/2012
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