MEDICARE: RAMESH P KANURU M.D.

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	207L00000X	Anesthesiology Physician	01029165A	IN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	01029165A	IN
3	208VP0014X	Interventional Pain Medicine Physician	01029165A	IN

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	:	1891772281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMESH P KANURU M.D.

Provider Business Mailing Address
First Line	:	3445 RIDGE RD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2049
Country	:	US
Telephone Number	:	219-838-1100
Fax Number	:	219-923-3501

Provider Business Practice Location Address
First Line	:	3445 RIDGE RD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2049
Country	:	US
Telephone Number	:	219-838-1100
Fax Number	:	219-923-3501

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	10/19/2022

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