Doctor Name: | SHRUTHI EDUNURI |
NPI Number: | 1073769113 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 1414 W Fair Ave Suite 36 Marquette, MI - 498552675 |
Business Phone Number: | 9062253864 |
Business Fax Number: | 9062253851 |
Mailing Address: | 4602 Dept, CAROL STREAM |
State: | IL |
Postal Code: | 601220021 |
Phone Number: | 9062254821 |
Fax Number: | 9062254537 |
NPI Enumeration Date: | 08/08/2008 |
NPI Last Update Date: | 04/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |