Provider Demographics
NPI:1972620250
Name:KONDURI, KAMESWARI SURYA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMESWARI
Middle Name:SURYA
Last Name:KONDURI
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 1:2300 SOUTHERN OAK DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3489
Mailing Address - Country:US
Mailing Address - Phone:972-444-9626
Mailing Address - Fax:
Practice Address - Street 1:1115 KINWEST PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3409
Practice Address - Country:US
Practice Address - Phone:972-401-0545
Practice Address - Fax:972-401-0614
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2678207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199239801Medicaid
TX8BQ921OtherBCBS
WIG45564Medicare UPIN
TX199239801Medicaid