MEDICARE: CHAITANYA KONDA D.O.

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	S2377	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	S2377	TX
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	S2377	TX

General Provider Information

NPI Number	:	1881088052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAITANYA KONDA D.O.

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-2153
Country	:	US
Telephone Number	:	214-645-2080
Fax Number	:

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	02/23/2023

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Directions to “ CHAITANYA KONDA D.O.” Practice Location

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