Healthcare Provider Details

I. General information

NPI: 1508819434
Provider Name (Legal Business Name): ASHOK KUMAR KONDUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 300
DEARBORN MI
48126-2619
US

IV. Provider business mailing address

5250 AUTO CLUB DR STE 300
DEARBORN MI
48126-2619
US

V. Phone/Fax

Practice location:
  • Phone: 313-724-9000
  • Fax: 313-908-9318
Mailing address:
  • Phone: 313-724-9000
  • Fax: 313-633-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number4301077525
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301077525
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301077525
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301077525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: