Provider Demographics
NPI:1033808498
Name:PRASAD, KONDRAGUNTA RAJENDRA (MD)
Entity Type:Individual
Prefix:PROF
First Name:KONDRAGUNTA
Middle Name:RAJENDRA
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6400
Mailing Address - Fax:414-955-0213
Practice Address - Street 1:9200 W WISCONSIN AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6400
Practice Address - Fax:414-955-0213
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-08
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Provider Licenses
StateLicense IDTaxonomies
WI9-8762086X0206X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology