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Individual

DR. KIRAN BABU BANDARU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2013017443
MO
208M00000X
Hospitalist Physician
Primary
2013017443
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1376721209
MO
01
431560263
TRICARE
MO
01
P01246683
RR MCR
MN
Enumeration date
02/01/2008
Last updated
05/08/2017
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