Healthcare Provider Details

I. General information

NPI: 1689639197
Provider Name (Legal Business Name): MADHAVI GUNDA CHUNDURU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADHAVI GUNDA

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103400 OVERSEAS HWY SUITE #200
KEY LARGO FL
33037
US

IV. Provider business mailing address

PO BOX 9507
TAVERNIER FL
33070-9507
US

V. Phone/Fax

Practice location:
  • Phone: 305-853-7171
  • Fax: 305-853-7151
Mailing address:
  • Phone: 305-853-7171
  • Fax: 305-853-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME86926
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME86926
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberME86926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: