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: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 PARDEE RD
TAYLOR MI
48180-2755
US

IV. Provider business mailing address

9029 PARDEE RD
TAYLOR MI
48180-2755
US

V. Phone/Fax

Practice location:
  • Phone: 313-437-8427
  • Fax: 313-437-8429
Mailing address:
  • Phone: 313-437-8427
  • Fax: 313-437-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: