Individual
DR. PRAMOD KUMAR PONNA
Inactive
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(248) 858-3244
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101276921
VA
207R00000X
Internal Medicine Physician
Primary
324263
LA
Other
Enumeration date
05/10/2017
Last updated
08/18/2023
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