Provider Demographics
NPI:1912253766
Name:KOLLI, SWAPNA (MD)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:KOLLI
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 1:1512 TEASLEY LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7282
Mailing Address - Country:US
Mailing Address - Phone:940-442-5209
Mailing Address - Fax:940-222-2720
Practice Address - Street 1:2609 SCRIPTURE ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2302
Practice Address - Country:US
Practice Address - Phone:940-442-5209
Practice Address - Fax:940-222-2720
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015025217207R00000X, 207R00000X
TXR7252207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912253766Medicaid
MO1912253766Medicaid