Provider Demographics
NPI:1407891591
Name:GONDI, JYOTHI (MD)
Entity Type:Individual
Prefix:MRS
First Name:JYOTHI
Middle Name:
Last Name:GONDI
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 1:6532 SPRING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8135
Mailing Address - Country:US
Mailing Address - Phone:815-323-1133
Mailing Address - Fax:815-323-1131
Practice Address - Street 1:303 ANDREWS DR
Practice Address - Street 2:# 200
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3918
Practice Address - Country:US
Practice Address - Phone:815-323-1133
Practice Address - Fax:815-323-1131
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212681 K23145Medicare ID - Type Unspecified
ILB53138Medicare UPIN