Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 2008037611 | MO |
NPI | 1649418807 |
---|---|
Provider Name | Sarvalakshmi Duriseti |
First Address | Hannibal, MO 63401-6877 |
Second Address | Hannibal, MO 63401-6877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 27/01/2009 |