Individual
VIDYA KOLLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
576 FORT LOUDON MEDICAL CENTER DR STE 203, LENOIR CITY, TN 37772-5676
(865) 271-6095
Mailing address
1345 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1844
(563) 421-1900
(563) 421-1809
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD-43419
IA
207R00000X
Internal Medicine Physician
V0278
TX
207RH0003X
Hematology & Oncology Physician
Primary
69007
WI
207RH0003X
Hematology & Oncology Physician
V0278
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710346671
—
WI
05
—
Q095555
—
TN
Enumeration date
02/19/2016
Last updated
12/19/2024
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