MEDICARE: DURGA R KANURU MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	01031561A	IN

General Provider Information

NPI Number	:	1386966240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURGA R KANURU MD PC

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

Provider Business Practice Location Address
First Line	:	3445 RIDGE RD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2049
Country	:	US
Telephone Number	:	219-838-1100
Fax Number	:	219-923-3501

Authorized Official
Title or Position	:	BILLING DEPT.
Name	:	MS. ROBIN RENEE SUMMERRISE
Credential	:
Telephone Number	:	219-838-1100

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	05/10/2010

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