=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386966240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURGA R KANURU MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2010
-----------------------------------------------------
Last Update Date | 05/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3445 RIDGE RD
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-838-1100
-----------------------------------------------------
Fax | 219-923-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 RIDGE RD
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-838-1100
-----------------------------------------------------
Fax | 219-923-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING DEPT.
-----------------------------------------------------
Name | MS. ROBIN RENEE SUMMERRISE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-838-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 01031561A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------