Provider Demographics
NPI:1346249927
Name:KONDAMURI, SAVEEN (MD)
Entity Type:Individual
Prefix:
First Name:SAVEEN
Middle Name:
Last Name:KONDAMURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 CALUMET AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2545
Mailing Address - Country:US
Mailing Address - Phone:219-836-7246
Mailing Address - Fax:219-836-6454
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2529
Practice Address - Country:US
Practice Address - Phone:219-836-7246
Practice Address - Fax:219-836-6454
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049412A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01049412AOtherBCBS OF ILLINOIS
IN000000217296OtherBLUE CROSS BLUE SHIELD
IN1962401745OtherGROUP NPI
IN01049412AOtherLICENSE NUMBER
IN200224020AMedicaid
GAP00635867OtherMEDICARE RAILROAD
GAP00635867OtherMEDICARE RAILROAD
IN1962401745OtherGROUP NPI