Provider Demographics
NPI:1023025863
Name:KONDLE, VENU M (MD)
Entity Type:Individual
Prefix:
First Name:VENU
Middle Name:M
Last Name:KONDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PLUMAS CT
Mailing Address - Street 2:STE C
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2971
Mailing Address - Country:US
Mailing Address - Phone:530-822-5575
Mailing Address - Fax:530-822-5585
Practice Address - Street 1:1525 PLUMAS CT
Practice Address - Street 2:STE C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2971
Practice Address - Country:US
Practice Address - Phone:530-749-3653
Practice Address - Fax:530-749-3495
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73939207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A739390Medicaid
P00355059OtherMEDICARE RAILROAD #
P00355059OtherMEDICARE RAILROAD #
CA00A739394Medicare PIN