Basic Information
Provider Information | |||||||||
NPI: | 1962026104 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUNTA | ||||||||
FirstName: | SATYA | ||||||||
MiddleName: | PREETHAM | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF MEDICINE | ||||||||
Address2: | 2411 HOLMES STREET M2-301, GRADUATE MEDICAL EDUCATION | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 64108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162356627 | ||||||||
FaxNumber: | 8162356629 | ||||||||
Practice Location | |||||||||
Address1: | TRUMAN MEDICAL CENTER | ||||||||
Address2: | 2301 HOLMES ST | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 64108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8164040957 | ||||||||
FaxNumber: | 8164040003 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2020 | ||||||||
LastUpdateDate: | 08/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2020019019 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 390200000X |   | MO | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 390200000X | 2020019019 | MO | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.