MEDICARE: VIJAY K KONDA 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	207R00000X	Internal Medicine Physician	ME96103	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1366556821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAY K KONDA MD

Provider Business Mailing Address
First Line	:	1879 VETERANS PARK DR STE 1202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0500
Country	:	US
Telephone Number	:	239-260-7610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1879 VETERANS PARK DR STE 1202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0500
Country	:	US
Telephone Number	:	239-260-7610
Fax Number	:	239-260-7615

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/03/2020

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