Provider Demographics
NPI:1306833744
Name:KANURU, SRIHARI DAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIHARI
Middle Name:DAS
Last Name:KANURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DAS
Other - Middle Name:S
Other - Last Name:KANURU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:234 KELLER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1417
Mailing Address - Country:US
Mailing Address - Phone:256-386-4300
Mailing Address - Fax:256-314-4472
Practice Address - Street 1:234 KELLER PARK BLVD
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1417
Practice Address - Country:US
Practice Address - Phone:256-386-4300
Practice Address - Fax:256-314-4472
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003370Medicaid
AL051003370OtherBLUE CROSS
AL000003370Medicaid