Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 17550 | OK |
NPI | 1134214794 |
---|---|
Provider Name | Dr. Sudhakara R. Kunamneni |
First Address | Norman, OK 73071-6425 |
Second Address | Norman, OK 73071-6425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17550 | MEDICA LICENSE NUMBER (01) | OK |
AK3210147 | DEA (01) | CA |
C50775 | LICENSE (01) | CA |