Healthcare Provider Details

I. General information

NPI: 1306833744
Provider Name (Legal Business Name): SRIHARI DAS KANURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAS S KANURU MD

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 KELLER PARK BLVD
TUSCUMBIA AL
35674-1417
US

IV. Provider business mailing address

234 KELLER PARK BLVD
TUSCUMBIA AL
35674-1417
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 Code208000000X
TaxonomyPediatrics Physician
License Number00007320
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: