Individual
MR. KISHAN MARK THADIKONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 E NORTH AVE STE 401, PITTSBURGH, PA 15212-4756
(412) 359-4352
Mailing address
320 E NORTH AVE STE 401, PITTSBURGH, PA 15212-4756
(412) 359-4352
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD480485
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16127341
CAQH
—
Enumeration date
04/30/2017
Last updated
08/01/2024
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