Provider Demographics
NPI:1548286743
Name:KURRA, SHANKAR (MD)
Entity type:Individual
Prefix:
First Name:SHANKAR
Middle Name:
Last Name:KURRA
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 1:272 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2374
Mailing Address - Country:US
Mailing Address - Phone:419-668-8101
Mailing Address - Fax:419-660-2686
Practice Address - Street 1:272 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:419-668-8101
Practice Address - Fax:419-660-2686
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047100207P00000X
OH35-092212207P00000X, 208M00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200174730Medicaid
OH2871398Medicaid
OH000000581380OtherANTHEM
IN200174730Medicaid
OH2871398Medicaid
IN178650EEMedicare ID - Type Unspecified
IN142520NNMedicare ID - Type Unspecified
OH4247362Medicare PIN
IN200174730Medicaid