1932246212 NPI number — PADMAJA KONDAMURI M.D.

Table of content: PADMAJA KONDAMURI M.D. (NPI 1932246212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932246212 NPI number — PADMAJA KONDAMURI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONDAMURI
Provider First Name:
PADMAJA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEELAVENI
Provider Other First Name:
PADMAJA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932246212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 OAKMONT LN
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-789-2550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8840 CALUMET AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-6422
Provider Business Practice Location Address Fax Number:
219-836-7245
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  01056972A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00136513 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000327090 . This is a "IN COMPREHENSIVE INS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000327090 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000327090 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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