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Organization
KONDA BC MOULI, MD PC
Active
Organization
KONDA BC MOULI, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE HOLDRIDGE (BILLING SPECIALIST)
(517) 265-0229
Entity
Organization
Contact information
Practice address
777 KIMOLE LN, SUITE 260, ADRIAN, MI 49221-1478
(517) 265-4770
Mailing address
777 KIMOLE LN, SUITE 260, ADRIAN, MI 49221-1478
(517) 265-4770
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340D610140
BCBSM
MI
Enumeration date
02/05/2008
Last updated
11/25/2008
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