MEDICARE: ADITYA MALATHESHA KONDAJJI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063162477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADITYA MALATHESHA KONDAJJI

Provider Business Mailing Address
First Line	:	11000 WEYBURN DR APT 401
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2832
Country	:	US
Telephone Number	:	512-284-3421
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2832
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/28/2023

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