Provider Demographics
NPI:1255738472
Name:ASHOK KONDUR MD PC
Entity type:Organization
Organization Name:ASHOK KONDUR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KONDUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-831-1100
Mailing Address - Street 1:4160 JOHN R ST STE 525
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2022
Mailing Address - Country:US
Mailing Address - Phone:313-831-1100
Mailing Address - Fax:313-831-1177
Practice Address - Street 1:4160 JOHN R ST STE 525
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2022
Practice Address - Country:US
Practice Address - Phone:313-831-1100
Practice Address - Fax:313-831-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077525207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301077525Medicaid