MEDICARE: DR. SREENIVASA S JONNALAGADDA MD

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	207RG0100X	Gastroenterology Physician	0435695	KS
2	207RG0100X	Gastroenterology Physician	101430	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376569673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SREENIVASA S JONNALAGADDA MD

Provider Business Mailing Address
First Line	:	901 E 104TH ST
Second Line	:	MAILSTOP 400
City	:	KANSAS CITY
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	816-599-9499
Fax Number	:	816-932-9670

Provider Business Practice Location Address
First Line	:	4321 WASHINGTON ST STE 5100
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5933
Country	:	US
Telephone Number	:	913-491-9100
Fax Number	:	913-491-9135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/08/2017

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