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General NPI Number Information
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NPI Number | 1306814561
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Entity Type | Individual
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Provider Name | KONDRAGANTI P RAO MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 28111 HOOVER
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-573-0589
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Fax | 586-573-3861
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Provider Business Mailing Address
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Address Line | 50 N DEEPLANDS ROAD
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City | GROSSE POINTE SHORES
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State | MI
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Zip | 48236
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Country | US
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Telephone | 586-573-0589
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Fax | 586-573-3861
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301032931
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301032931
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License Number State | MI
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