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General NPI Number Information
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NPI Number | 1255738472
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Entity Type | Organization
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Legal Business Name | ASHOK KONDUR MD PC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 4160 JOHN R ST STE 525
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City | DETROIT
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State | MI
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Zip | 48201-2022
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Country | US
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Telephone | 313-831-1100
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Fax | 313-831-1177
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Provider Business Mailing Address
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Address Line | 4160 JOHN R ST STE 525
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City | DETROIT
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State | MI
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Zip | 48201-2022
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Country | US
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Telephone | 313-831-1100
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Fax | 313-831-1177
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Authorized Official
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Title or Position | MD/OWNER
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Name | ASHOK KUMAR KONDUR
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Credential | MD
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Telephone | 313-831-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 4301077525
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License Number State | MI
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