Individual
DR. PREM K KONAKONDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-2345
Mailing address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01067488A
IN
207R00000X
Internal Medicine Physician
11014069A
IN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
01067488A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200979950
—
IN
Enumeration date
06/05/2008
Last updated
09/23/2024
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