Provider Demographics
NPI:1477599587
Name:KONERU, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:KONERU
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 1:33376 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5966
Mailing Address - Country:US
Mailing Address - Phone:586-722-7440
Mailing Address - Fax:586-722-7675
Practice Address - Street 1:33376 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5966
Practice Address - Country:US
Practice Address - Phone:586-722-7440
Practice Address - Fax:586-722-7675
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080674207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58723OtherHAP
136847OtherCARE CHOICES
MI449652010Medicaid
110E014810OtherBCBS
16829OtherMCARE
P00012493OtherPALMETTO
136847OtherPREFERRED CHOICES
144732OtherGREAT LAKES
110E014810OtherBCN
136847OtherCAPE
921607OtherOMNI
G58723OtherHAP
N70490002Medicare ID - Type Unspecified