Individual
PRASADARAO KONDAPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15000 MADISON AVE, LAKEWOOD, OH 44107-4014
(216) 227-1595
(216) 227-9465
Mailing address
20525 CENTER RIDGE RD, STE 220, ROCKY RIVER, OH 44116
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35042650
OH
207RP1001X
Pulmonary Disease Physician
35042650K
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119204
GROUP MEDICAID
—
05
—
0428504
—
OH
01
—
10794333
CAQH
—
01
—
109902
KAISER
—
01
—
1780634279
GROUP NPI
—
01
—
3610861
GROUP ASC MEDICARE
—
01
—
9273172
GROUP MEDICARE
—
01
—
CA4511
GROUP RR MEDICARE
—
01
—
D368301
GROUP IND DIAGNOSTICS MED
—
Enumeration date
03/07/2006
Last updated
03/23/2017
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