Provider Demographics
NPI:1023229036
Name:KONDUR, SRUTHI (MD)
Entity type:Individual
Prefix:DR
First Name:SRUTHI
Middle Name:
Last Name:KONDUR
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 1:6255 INKSTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2538
Mailing Address - Country:US
Mailing Address - Phone:313-831-4800
Mailing Address - Fax:313-495-7104
Practice Address - Street 1:6255 INKSTER RD STE 105
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2538
Practice Address - Country:US
Practice Address - Phone:313-831-4800
Practice Address - Fax:313-495-7104
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086330207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology