MEDICARE: DR. KAMESWARI SURYA KONDURI 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	207KA0200X	Allergy Physician	M2678	TX

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	8BQ921	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1972620250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMESWARI SURYA KONDURI MD

Provider Business Mailing Address
First Line	:	2300 SOUTHERN OAK DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-3489
Country	:	US
Telephone Number	:	972-444-9626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 KINWEST PKWY
Second Line	:	SUITE 100
City	:	IRVING
State	:	TX
Zip	:	75063-3409
Country	:	US
Telephone Number	:	972-401-0545
Fax Number	:	972-401-0614

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/30/2009

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