Provider Demographics
NPI:1063511202
Name:BENNURI, BINDU (MD)
Entity Type:Individual
Prefix:DR
First Name:BINDU
Middle Name:
Last Name:BENNURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 20TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3832
Mailing Address - Country:US
Mailing Address - Phone:205-333-5900
Mailing Address - Fax:205-333-6090
Practice Address - Street 1:2701 20TH AVENUE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3832
Practice Address - Country:US
Practice Address - Phone:205-333-5900
Practice Address - Fax:205-333-6090
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22399207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009978015Medicaid
AL009978015Medicaid
AL051555452Medicare ID - Type Unspecified