Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2006023105 | MO |
Y | 208600000X | Surgeon | 2006023105 | MO |
NPI | 1003901349 |
---|---|
Provider Name | Satish Ponnuru |
First Address | Kansas City, MO 64111-5961 |
Second Address | Kansas City, MO 64111-5941 |
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 |