Healthcare Provider Details

I. General information

NPI: 1275160384
Provider Name (Legal Business Name): VARUN C SANKURATRI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S NATIONAL AVE STE 250
SPRINGFIELD MO
65807-7304
US

IV. Provider business mailing address

3231 S NATIONAL AVE STE 250
SPRINGFIELD MO
65807-7304
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-0827
  • Fax:
Mailing address:
  • Phone: 417-885-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2023041281
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5151014316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: