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General NPI Number Information
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NPI Number | 1336116565
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Entity Type | Individual
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Provider Name | PRASADARAO KONDAPALLI MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 15000 MADISON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4014
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Country | US
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Telephone | 216-227-1595
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Fax | 216-227-9465
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Provider Business Mailing Address
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Address Line | 20525 CENTER RIDGE RD STE 220
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City | ROCKY RIVER
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State | OH
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Zip | 44116
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Country | US
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Telephone | 440-895-5056
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Fax | 440-333-2935
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 35042650K
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35042650
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License Number State | OH
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