Provider Demographics
NPI:1144251430
Name:PONNURU, HARISH (MD)
Entity type:Individual
Prefix:DR
First Name:HARISH
Middle Name:
Last Name:PONNURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3749
Mailing Address - Country:US
Mailing Address - Phone:913-339-9355
Mailing Address - Fax:913-339-9364
Practice Address - Street 1:5701 W 119TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3750
Practice Address - Country:US
Practice Address - Phone:913-339-9355
Practice Address - Fax:913-339-9364
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA152669OtherRAILROAD MEDICARE
KS200267510AMedicaid
MO203756234Medicaid
MO25153024OtherBLUE CROSS BLUE SHIELD
KS7590017OtherAETNA
KS1886926OtherUNITED HEALTHCARE
MO25153024OtherBLUE CROSS BLUE SHIELD
G59890Medicare UPIN