Provider Demographics
NPI:1407387368
Name:KONUTHULA, NEERAJA (MD)
Entity Type:Individual
Prefix:
First Name:NEERAJA
Middle Name:
Last Name:KONUTHULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 NW 14TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2106
Mailing Address - Country:US
Mailing Address - Phone:305-243-6466
Mailing Address - Fax:305-243-1651
Practice Address - Street 1:1121 NW 14TH ST FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2106
Practice Address - Country:US
Practice Address - Phone:305-243-6466
Practice Address - Fax:305-243-1651
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME161159207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program