Provider Demographics
NPI:1326045543
Name:KONA, SUGUNA R (MD)
Entity Type:Individual
Prefix:
First Name:SUGUNA
Middle Name:R
Last Name:KONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:4502 CORTEZ RD W STE 205
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3124
Practice Address - Country:US
Practice Address - Phone:941-259-8505
Practice Address - Fax:941-792-7152
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME84995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280622300Medicaid
FL280622300Medicaid
FL13050XMedicare PIN