Basic Information
| Provider Information | |||||||||
| NPI: | 1003901349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONNURU | ||||||||
| FirstName: | SATISH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4321 WASHINGTON ST | ||||||||
| Address2: | SUITE 4000 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641115961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169324549 | ||||||||
| FaxNumber: | 8169325793 | ||||||||
| Practice Location | |||||||||
| Address1: | 4320 WORNALL RD | ||||||||
| Address2: | SUITE 513 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641115941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169324549 | ||||||||
| FaxNumber: | 8169325793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 2006023105 | MO | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.