Provider Demographics
NPI:1689670531
Name:KONERU, BHAVANI (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:
Last Name:KONERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3846
Mailing Address - Country:US
Mailing Address - Phone:419-291-2200
Mailing Address - Fax:419-479-3298
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3846
Practice Address - Country:US
Practice Address - Phone:419-291-2200
Practice Address - Fax:419-479-3298
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196903Medicaid
OH341881137OtherFRONT PATH
OH07603OtherPARAMOUNT
MI1689670531Medicaid
MI12802OtherHEALTH PLAN OF MICHIGAN
OH141978OtherPRIORITY
OH1689670531OtherCIGNA
OH7779163OtherAETNA
OH07603OtherPARAMOUNT
MI1689670531Medicaid
OHH150550Medicare PIN