Individual
SRIDEVI KORITALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2000 E. LAYTON AVE., ST. FRANCIS, WI 53235-6053
(414) 744-6589
(414) 747-8848
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38621
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32497100
—
WI
Enumeration date
11/01/2006
Last updated
01/15/2025
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