# KONDA BC MOULI, MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376721035
- **Authorized official:** JULIE HOLDRIDGE (BILLING SPECIALIST)
- **Authorized official phone:** (517) 265-0229

## Contact information

- **Practice address:** 777 KIMOLE LN, SUITE 260, ADRIAN, MI 49221-1478
- **Practice address phone:** (517) 265-4770
- **Mailing address:** 777 KIMOLE LN, SUITE 260, ADRIAN, MI 49221-1478
- **Mailing address phone:** (517) 265-4770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2008
- **Last updated:** 11/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 340D610140 | BCBSM | MI |