Basic Information
| Provider Information | |||||||||
| NPI: | 1396278099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONDA | ||||||||
| FirstName: | SASANK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 W. GRAND BLVD., 8TH FLOOR | ||||||||
| Address2: | DEPT. OF DERMATOLOGY | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139162171 | ||||||||
| FaxNumber: | 3139162093 | ||||||||
| Practice Location | |||||||||
| Address1: | 2799 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
| FaxNumber: | 3138761305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 4301114438 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | 125.070725 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 4301504882 | MI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.