Provider Demographics
NPI:1033524897
Name:BANTU, SRAVANI (MD)
Entity type:Individual
Prefix:
First Name:SRAVANI
Middle Name:
Last Name:BANTU
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:PO BOX 2345
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2345
Mailing Address - Country:US
Mailing Address - Phone:256-235-5639
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHWAY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1951
Practice Address - Country:US
Practice Address - Phone:256-231-7500
Practice Address - Fax:256-231-7501
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36261207R00000X
WV6253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine