Individual
PHANI SURAPANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
324387
LA
207RC0000X
Cardiovascular Disease Physician
Primary
324387
LA
207RC0000X
Cardiovascular Disease Physician
46132
IA
Other
Enumeration date
06/24/2012
Last updated
03/14/2023
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