Provider Demographics
NPI:1376569673
Name:JONNALAGADDA, SREENIVASA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SREENIVASA
Middle Name:S
Last Name:JONNALAGADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-599-9499
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST STE 5100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5933
Practice Address - Country:US
Practice Address - Phone:913-491-9100
Practice Address - Fax:913-491-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0435695207RG0100X
MO101430207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207983420Medicaid
G07016Medicare UPIN
MO207983420Medicaid
KSW19A00083Medicare PIN
110187688Medicare PIN
233010183Medicare PIN
233010183Medicare PIN