Basic Information
| Provider Information | |||||||||
| NPI: | 1376737346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONDA | ||||||||
| FirstName: | SUDHAKAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 N EDWARD ST | ||||||||
| Address2: | BUSINESS OFFICE | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625264163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178762857 | ||||||||
| FaxNumber: | 2178762249 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 W HAY ST | ||||||||
| Address2: | LOWER LEVEL SUITE 110 | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625266304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178766330 | ||||||||
| FaxNumber: | 2178766335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-124365 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.