Provider Demographics
NPI:1003998840
Name:GOVINDARAJU, KANAKADURGA (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAKADURGA
Middle Name:
Last Name:GOVINDARAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8645
Mailing Address - Country:US
Mailing Address - Phone:512-397-3360
Mailing Address - Fax:512-343-7107
Practice Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8645
Practice Address - Country:US
Practice Address - Phone:512-397-3360
Practice Address - Fax:512-343-7107
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065815207Q00000X
TXL3318207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193186707Medicaid
TX193186712Medicaid
TX193186706Medicaid
TX106362OtherMEDICARE
TX193618708Medicaid
H15056Medicare UPIN