Provider Demographics
NPI:1508989260
Name:KONERU, NAGENDRA SAI (MD)
Entity Type:Individual
Prefix:
First Name:NAGENDRA
Middle Name:SAI
Last Name:KONERU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:KONERU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-1086
Mailing Address - Country:US
Mailing Address - Phone:563-556-3175
Mailing Address - Fax:563-594-5256
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:WENDT REGIONAL CANCER CENTER
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-589-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI507382085R0001X
IA397412085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316231012Medicaid
WI34936900Medicaid
IA1316231012Medicaid