Individual
DR. PRAVEENA GORANTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1921 N WEBB RD, WICHITA, KS 67206-3405
(316) 612-4815
(316) 612-4825
Mailing address
1921 N WEBB RD, WICHITA, KS 67206-3405
(316) 612-4815
(316) 612-4825
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
04-33130
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200569320A
—
KS
01
—
P01144793
RR MEDICARE
—
Enumeration date
11/07/2007
Last updated
08/16/2024
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