Healthcare Provider Details

I. General information

NPI: 1386966240
Provider Name (Legal Business Name): DURGA R KANURU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 RIDGE RD
HIGHLAND IN
46322-2049
US

IV. Provider business mailing address

3445 RIDGE RD
HIGHLAND IN
46322-2049
US

V. Phone/Fax

Practice location:
  • Phone: 219-838-1100
  • Fax: 219-923-3501
Mailing address:
  • Phone: 219-838-1100
  • Fax: 219-923-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01031561A
License Number StateIN

VIII. Authorized Official

Name: MS. ROBIN RENEE SUMMERRISE
Title or Position: BILLING DEPT.
Credential:
Phone: 219-838-1100