MEDICARE: DR. JHANSI L KODURI MD

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	207RH0003X	Hematology & Oncology Physician	35084381	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000389984	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164478772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JHANSI L KODURI MD

Provider Business Mailing Address
First Line	:	1029 WHISPERING PINE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6061
Country	:	US
Telephone Number	:	937-286-2638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 WHISPERING PINE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6061
Country	:	US
Telephone Number	:	937-286-2638
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	05/07/2026

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