Provider Demographics
NPI:1932246212
Name:KONDAMURI, PADMAJA (MD)
Entity Type:Individual
Prefix:
First Name:PADMAJA
Middle Name:
Last Name:KONDAMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMAJA
Other - Middle Name:
Other - Last Name:NEELAVENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2529
Practice Address - Country:US
Practice Address - Phone:219-836-6422
Practice Address - Fax:219-836-7245
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056972A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00136513OtherRAILROAD MEDICARE
IN000000327090OtherIN COMPREHENSIVE INS
IN000000327090OtherANTHEM
IN000000327090OtherBCBS PROVIDER ID
IN000000327090OtherBCBS PROVIDER ID
ILG34870Medicare UPIN
IN000000327090OtherANTHEM