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General NPI Number Information
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NPI Number | 1144251430
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Entity Type | Individual
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Provider Name | HARISH PONNURU MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5701 W 119TH ST STE 150
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City | OVERLAND PARK
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State | KS
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Zip | 66209-3750
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Country | US
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Telephone | 913-339-9355
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Fax | 913-339-9364
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Provider Business Mailing Address
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Address Line | 5701 W 119TH ST SUITE 150
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City | OVERLAND PARK
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State | KS
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Zip | 66209-3749
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Country | US
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Telephone | 913-339-9355
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Fax | 913-339-9364
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0430601
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License Number State | KS
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