Provider Demographics
NPI:1174612907
Name:KANURI, KARUNASREE (MD,)
Entity type:Individual
Prefix:DR
First Name:KARUNASREE
Middle Name:
Last Name:KANURI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3309
Mailing Address - Country:US
Mailing Address - Phone:304-831-0085
Mailing Address - Fax:304-831-0088
Practice Address - Street 1:1115 2ND AVE
Practice Address - Street 2:
Practice Address - City:WEST LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3309
Practice Address - Country:US
Practice Address - Phone:304-831-0085
Practice Address - Fax:304-831-0088
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003597Medicaid
WVW9357791Medicare ID - Type Unspecified
WV3810003597Medicaid