Provider Demographics
NPI:1487610861
Name:SREENARASIMHAIAH, SREEDEVI (MD)
Entity type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:
Last Name:SREENARASIMHAIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-749-4000
Mailing Address - Fax:920-749-4015
Practice Address - Street 1:2501 E ENTERPRISE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7805
Practice Address - Country:US
Practice Address - Phone:920-729-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50218-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147123701Medicaid
TX147123701Medicaid