Provider Demographics
NPI:1437159563
Name:KANURU, DURGA R (MD)
Entity Type:Individual
Prefix:
First Name:DURGA
Middle Name:R
Last Name:KANURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DURGA
Other - Middle Name:R
Other - Last Name:YARAGADDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1574
Mailing Address - Country:US
Mailing Address - Phone:219-836-0000
Mailing Address - Fax:219-836-2788
Practice Address - Street 1:110 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1574
Practice Address - Country:US
Practice Address - Phone:219-836-0000
Practice Address - Fax:219-836-2788
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031561A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN256700IOtherMEDICARE PTAN
IN100168550Medicaid
IN100168550Medicaid