Individual
PRAVEEN KANNEGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34612 6TH AVE S STE 300, FEDERAL WAY, WA 98003-8723
(253) 838-8552
(253) 272-0149
Mailing address
34612 6TH AVE S STE 300, FEDERAL WAY, WA 98003-8723
(253) 838-8552
(253) 272-0149
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD60819307
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
125.069745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2108169
—
WA
Enumeration date
06/29/2012
Last updated
07/21/2022
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