Individual
RAGHU KANUMURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8500
(800) 968-6866
Mailing address
PO BOX 66971, DEPT LE, SAINT LOUIS, MO 63166-6971
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-101187
IL
207Q00000X
Family Medicine Physician
036101187
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101187
—
IL
05
—
036101187-9
—
IL
05
—
209158815
—
MO
Enumeration date
11/21/2005
Last updated
08/27/2019
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