Provider Demographics
NPI:1154373397
Name:SREERAMA, RAVI KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KUMAR
Last Name:SREERAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-2982
Mailing Address - Country:US
Mailing Address - Phone:903-427-5682
Mailing Address - Fax:903-427-2148
Practice Address - Street 1:103 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-2982
Practice Address - Country:US
Practice Address - Phone:903-427-5682
Practice Address - Fax:903-427-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118459OtherSUPERIOR HEALTH
TX45D0663902OtherCLIA
TX130504705Medicaid
TX00B81UOtherBCBS
TX118459OtherSUPERIOR HEALTH
TX45D0663902OtherCLIA
TXC74142Medicare UPIN