Healthcare Provider Details

I. General information

NPI: 1215092796
Provider Name (Legal Business Name): DAS S. KANURU, M. D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S JACKSON HWY SUITE 100
SHEFFIELD AL
35660-5769
US

IV. Provider business mailing address

1100 S JACKSON HWY SUITE 100
SHEFFIELD AL
35660-5769
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-4300
  • Fax: 256-314-4472
Mailing address:
  • Phone: 256-386-4300
  • Fax: 256-314-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7320
License Number StateAL

VIII. Authorized Official

Name: DR. DAS S. KANURU
Title or Position: OWNER
Credential: M. D.
Phone: 256-386-4300