Provider Demographics
NPI:1699015388
Name:ELESWARAPU, SRIRAM VENKATA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SRIRAM
Middle Name:VENKATA
Last Name:ELESWARAPU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 W ALAMEDA AVE STE 310
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4819
Practice Address - Country:US
Practice Address - Phone:310-794-7700
Practice Address - Fax:818-260-8718
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA155388208800000X, 208800000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program