Provider Demographics
NPI:1487899613
Name:KANURI, RAVI TEJA (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:TEJA
Last Name:KANURI
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 1:1200 BINZ ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6926
Mailing Address - Country:US
Mailing Address - Phone:832-973-8167
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:1200 BINZ ST STE 1200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6926
Practice Address - Country:US
Practice Address - Phone:832-973-8167
Practice Address - Fax:210-617-4075
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR217289207RH0002X
MN74522207RH0002X
TXP2274208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I116587Medicare PIN