Individual
DR. HARISH PONNURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5701 W 119TH ST STE 150, OVERLAND PARK, KS 66209-3750
(913) 339-9355
(913) 339-9364
Mailing address
5701 W 119TH ST, SUITE 150, OVERLAND PARK, KS 66209-3749
(913) 339-9355
(913) 339-9364
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0430601
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152669
RAILROAD MEDICARE
GA
01
—
1886926
UNITED HEALTHCARE
KS
05
—
200267510A
—
KS
05
—
203756234
—
MO
01
—
25153024
BLUE CROSS BLUE SHIELD
MO
01
—
7590017
AETNA
KS
Enumeration date
07/05/2006
Last updated
07/21/2022
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