Provider Demographics
NPI:1396738282
Name:GONDI, RAMA K (MD)
Entity type:Individual
Prefix:
First Name:RAMA
Middle Name:K
Last Name:GONDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11125 DUNN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036109540207RC0000X
MO2003012641207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
021291OtherFMH
566489OtherHEALTHLINK
ILP00341379OtherILRRMCR
8029043OtherCIGNA
7471506OtherAETNA
000000012077OtherESSENCE
195651OtherBLUE CHOICE
021291OtherJFMOLLOY
MO195651OtherMO BC/BS
2299725OtherUHC
H86336OtherMERCY
MO208998823Medicaid
231679OtherGHP
MOC50434OtherMORRMCR
2299725OtherUHC
8029043OtherCIGNA
566489OtherHEALTHLINK
MO603221207Medicare PIN
195651OtherBLUE CHOICE