Provider Demographics
NPI:1134214794
Name:KUNAMNENI, SUDHAKARA R (MD,)
Entity type:Individual
Prefix:DR
First Name:SUDHAKARA
Middle Name:R
Last Name:KUNAMNENI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 208A
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6425
Mailing Address - Country:US
Mailing Address - Phone:405-579-1444
Mailing Address - Fax:405-579-1448
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 208A
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6425
Practice Address - Country:US
Practice Address - Phone:405-579-1444
Practice Address - Fax:405-579-1448
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK17550OtherMEDICA LICENSE NUMBER
CAC50775OtherLICENSE
CAC50775OtherLICENSE