Healthcare Provider Details

I. General information

NPI: 1396723904
Provider Name (Legal Business Name): SUDHIR GONDY RAO MD (MB;BS)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SECOR RD
TOLEDO OH
43623-4299
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4299
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5485
  • Fax: 419-479-5480
Mailing address:
  • Phone: 419-473-3561
  • Fax: 419-479-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.068589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: