Individual
SREENIVASA RAO TADIKONDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 PALEO DR, MONROE, LA 71203-8844
(318) 651-7410
Mailing address
120 PALEO DR, MONROE, LA 71203-8844
(318) 651-7410
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD.201751
LA
207Q00000X
Family Medicine Physician
MD201751
LA
208M00000X
Hospitalist Physician
MD.201751
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1071340
—
LA
Enumeration date
09/11/2007
Last updated
04/27/2021
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