Individual
DR. SRI VARDHAN REDDY KOOTURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2731
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2731
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11281
ND
207R00000X
Internal Medicine Physician
PT 11281
ND
390200000X
Student in an Organized Health Care Education/Training Program
RL10211
ND
Other
Enumeration date
10/01/2008
Last updated
11/22/2011
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