Provider Demographics
NPI:1659343630
Name:KONERU, SUDHIR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHIR
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 1:1515 DELHI ST SUITE 300
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-557-8500
Mailing Address - Fax:563-589-4050
Practice Address - Street 1:1515 DELHI ST SUITE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6320
Practice Address - Country:US
Practice Address - Phone:563-557-8500
Practice Address - Fax:563-589-4050
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20237207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31349500Medicaid
IA20237OtherSTATE MEDICAL LICENSE
IL4956566012Medicaid
IA0127845Medicaid
IAE54109Medicare UPIN
IA12784Medicare PIN