1386966240 NPI number — DURGA R KANURU MD PC

Table of content: (NPI 1386966240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386966240 NPI number — DURGA R KANURU MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURGA R KANURU MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED WOMENS WELLNESS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386966240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46322-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-838-1100
Provider Business Mailing Address Fax Number:
219-923-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-838-1100
Provider Business Practice Location Address Fax Number:
219-923-3501
Provider Enumeration Date:
02/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERRISE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
BILLING DEPT.
Authorized Official Telephone Number:
219-838-1100

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  01031561A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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