Healthcare Provider Details

I. General information

NPI: 1972714889
Provider Name (Legal Business Name): SAI KONDURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HEARNE AVE STE 301
SHREVEPORT LA
71103-3918
US

IV. Provider business mailing address

2727 HEARNE AVE SUITE 301
SHREVEPORT LA
71103
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-6400
  • Fax: 318-631-0300
Mailing address:
  • Phone: 318-631-6400
  • Fax: 318-631-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD201937
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35.146209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: