MEDICARE: DR S GUNNALA MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	27607	AZ

General Provider Information

NPI Number	:	1275840027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR S GUNNALA MD PC

Provider Business Mailing Address
First Line	:	19636 N 27TH AVE STE 207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4015
Country	:	US
Telephone Number	:	623-580-7245
Fax Number	:	602-864-1401

Provider Business Practice Location Address
First Line	:	19636 N 27TH AVE STE 207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4015
Country	:	US
Telephone Number	:	623-580-7245
Fax Number	:	602-864-1401

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. SHAUN KANAKA
Credential	:	MBA
Telephone Number	:	480-225-3065

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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