Individual
SRILATHA KONDURI GANNAVARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
20 NE SAINT LUKES BLVD, STE. 350, LEES SUMMIT, MO 64086-6001
(816) 347-5600
(816) 347-5674
Mailing address
901 E. 104TH ST, MAILSTOP 400N, KANSAS CITY, MO 64131
(816) 502-7104
(816) 932-9670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2007023617
MO
208M00000X
Hospitalist Physician
Primary
0436784
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467666834
—
MO
Enumeration date
05/09/2007
Last updated
02/28/2019
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