Provider Demographics
NPI:1689639197
Name:CHUNDURU, MADHAVI GUNDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MADHAVI
Middle Name:GUNDA
Last Name:CHUNDURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHAVI
Other - Middle Name:
Other - Last Name:GUNDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9507
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-9507
Mailing Address - Country:US
Mailing Address - Phone:305-853-7171
Mailing Address - Fax:305-853-7151
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:SUITE #200
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037
Practice Address - Country:US
Practice Address - Phone:305-853-7171
Practice Address - Fax:305-853-7151
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86926207RC0000X, 207RA0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG35826Medicare UPIN
FL29227Medicare PIN