Individual
DR. SRIDEVI KANURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
620 W EDISON RD, STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Mailing address
620 W EDISON RD, STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01069685A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
036123242
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201021510
—
IN
Enumeration date
04/09/2010
Last updated
08/24/2016
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