Provider Demographics
NPI:1962472217
Name:KONDROSKI, ELAINE M (M D)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:KONDROSKI
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-777-7888
Practice Address - Fax:321-773-7738
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME346492085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEOtherEVOLUTIONS
FL6975755OtherCIGNA
9725373OtherAETNA PPO
FLNONEOtherMULTIPLAN/PHCS
FL01421142OtherAMERIGROUP
FLNONEOtherBEECHSTREET
FLNONEOtherHUMANA CHOICE
FLNONEOtherUHC
FLP00921811OtherRAILROAD MEDICARE
FL253839300Medicaid
FL8011362OtherAETNA HMO
FLNONEOtherTRICARE
FL03865OtherBCBS OF FL
FL6975755OtherGREATWEST HEALTHCARE
FLNONEOtherCCN/COVENTRY/FIRSTHEALTH
9725373OtherAETNA PPO
FL03865RMedicare PIN