MEDICARE: DR. SUDHAKAR KONDA M.D.

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	207Q00000X	Family Medicine Physician	036-124365	IL

General Provider Information

NPI Number	:	1376737346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUDHAKAR KONDA M.D.

Provider Business Mailing Address
First Line	:	901 CRYSTAL FALLS PKWY OFC
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-1922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 CRYSTAL FALLS PKWY STE 103
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-1931
Country	:	US
Telephone Number	:	512-259-2198
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	01/19/2023

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