Healthcare Provider Details

I. General information

NPI: 1609189463
Provider Name (Legal Business Name): MILDRED A. OPONDO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 12/31/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

IV. Provider business mailing address

188 HAMPTON WAY
MACON GA
31220-8744
US

V. Phone/Fax

Practice location:
  • Phone: 785-623-5000
  • Fax:
Mailing address:
  • Phone: 770-605-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0450413
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number92357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: