Dr. Sri Vardhan Reddy Kooturu, M.D.
Internal Medicine in Fargo, ND. Individual provider (NPI-1).
NPI number1760633457
StatusActive
Last updated in NPPESNov 22, 2011
Details
- NPI
- 1760633457
- Entity type
- Individual (NPI-1)
- Name
- Dr. Sri Vardhan Reddy Kooturu
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 1, 2008
- Last updated
- Nov 22, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 11281 | ND | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | RL10211 | ND | |
| 207R00000X | Internal Medicine | PT 11281 | ND |
Practice location
801 Broadway NFargo, ND 58102-3641
Phone 701-234-2731
Mailing address
801 Broadway NFargo, ND 58102-3641
Phone 701-234-2731
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