Provider Demographics
NPI:1851828180
Name:PATLOLLA, SRIKANT (MD)
Entity type:Individual
Prefix:
First Name:SRIKANT
Middle Name:
Last Name:PATLOLLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRIKANT
Other - Middle Name:SHIVA
Other - Last Name:PATLOLLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:281 RED EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9774
Mailing Address - Country:US
Mailing Address - Phone:601-613-3427
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6348207RA0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program