Provider Demographics
NPI:1407808223
Name:KONDURI, GIRIJA G (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRIJA
Middle Name:G
Last Name:KONDURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF NEONATOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6452
Mailing Address - Fax:414-266-6979
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF NEONATOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6452
Practice Address - Fax:414-266-6979
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI421442080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
008000315BOtherHUMANA
WI32639600Medicaid
WI1407808223Medicaid
0008L73601Medicare ID - Type Unspecified
WI1407808223Medicaid
WI68086 0786Medicare PIN