MEDICARE: DEBORAH J KONDIS 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	207VG0400X	Gynecology Physician	MD17301	TN

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	3009669	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1750362711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH J KONDIS MD

Provider Business Mailing Address
First Line	:	2011 CHURCH ST
Second Line	:	SUITE 403
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2000
Country	:	US
Telephone Number	:	615-284-6555
Fax Number	:	615-284-6558

Provider Business Practice Location Address
First Line	:	2011 CHURCH ST
Second Line	:	SUITE 403
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2000
Country	:	US
Telephone Number	:	615-284-6555
Fax Number	:	615-284-6558

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	01/12/2010

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