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General NPI Number Information
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NPI Number | 1972620250
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Entity Type | Individual
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Provider Name | KAMESWARI SURYA KONDURI MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 1115 KINWEST PKWY SUITE 100
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City | IRVING
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State | TX
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Zip | 75063-3409
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Country | US
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Telephone | 972-401-0545
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Fax | 972-401-0614
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Provider Business Mailing Address
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Address Line | 2300 SOUTHERN OAK DR
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City | IRVING
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State | TX
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Zip | 75063-3489
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Country | US
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Telephone | 972-444-9626
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Fax |
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | M2678
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License Number State | TX
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