Provider Demographics
NPI:1538128236
Name:KONDA, JANARDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANARDHAN
Middle Name:
Last Name:KONDA
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 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:2811 DUKE OF GLOUCESTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2017
Practice Address - Country:US
Practice Address - Phone:972-780-7300
Practice Address - Fax:972-780-5817
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8923207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Y780OtherBCBSTX
TX100248701Medicaid
TX83Y780Medicare PIN
TXC18009Medicare UPIN
TX100007736Medicare PIN