Individual
PRAMEELA BANOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-4070
(816) 404-4075
Mailing address
2790 CLAY EDWARDS DR STE 410, NORTH KANSAS CITY, MO 64116-3274
(816) 474-0458
(816) 471-2723
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125055676
IL
207R00000X
Internal Medicine Physician
2012019401
MO
207RN0300X
Nephrology Physician
04-50503
KS
207RN0300X
Nephrology Physician
Primary
2012019401
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720395171
—
MO
05
—
193710001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01085133
MCR RR
MO
Enumeration date
09/07/2010
Last updated
06/02/2025
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