Provider Demographics
NPI:1396397006
Name:KONDA, RAGHUNANDAN (MD)
Entity Type:Individual
Prefix:
First Name:RAGHUNANDAN
Middle Name:
Last Name:KONDA
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:G3230 BEECHER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3604
Mailing Address - Country:US
Mailing Address - Phone:810-342-5800
Mailing Address - Fax:810-342-5810
Practice Address - Street 1:G3230 BEECHER RD STE 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3604
Practice Address - Country:US
Practice Address - Phone:810-342-5800
Practice Address - Fax:810-342-5810
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351044780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine