Provider Demographics
NPI:1770660144
Name:DASARI, KANTHI BALASUNDARAM (DO)
Entity Type:Individual
Prefix:DR
First Name:KANTHI
Middle Name:BALASUNDARAM
Last Name:DASARI
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2200 FT.ROOTS DR.
Mailing Address - Street 2:117/NLR
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114
Mailing Address - Country:US
Mailing Address - Phone:501-257-2991
Mailing Address - Fax:501-257-2993
Practice Address - Street 1:2200 FT.ROOTS DRIVE
Practice Address - Street 2:117/NLR
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-257-2991
Practice Address - Fax:501-257-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-4590208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARVAD000Medicare UPIN