MEDICARE: RAMA K GONDI MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036109540	IL
2	207RC0000X	Cardiovascular Disease Physician	2003012641	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021291	OTHER		FMH
2	566489	OTHER		HEALTHLINK
3	P00341379	OTHER	IL	ILRRMCR
4	8029043	OTHER		CIGNA
5	7471506	OTHER		AETNA
6	000000012077	OTHER		ESSENCE
7	195651	OTHER		BLUE CHOICE
8	021291	OTHER		JFMOLLOY
9	195651	OTHER	MO	MO BC/BS
10	2299725	OTHER		UHC
11	H86336	OTHER		MERCY
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	231679	OTHER		GHP
14	C50434	OTHER	MO	MORRMCR

NPI Number	:	1396738282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMA K GONDI MD

Provider Business Mailing Address
First Line	:	11125 DUNN RD
Second Line	:	SUITE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

Provider Business Practice Location Address
First Line	:	11125 DUNN RD
Second Line	:	SUITE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	12/08/2021

11125 DUNN RD , STE 402
SAINT LOUIS, MO
63136-6132

Practice Phone: 314-741-3400
Practice Fax: 314-741-4357

11125 DUNN RD , STE 204
SAINT LOUIS, MO
63136-6132