Individual
SASANK KONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(800) 653-6568
(313) 876-1305
Mailing address
3031 W. GRAND BLVD., 8TH FLOOR, DEPT. OF DERMATOLOGY, DETROIT, MI 48202
(313) 916-2171
(313) 916-2093
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
4301114438
MI
207N00000X
Dermatology Physician
Primary
4301504882
MI
207R00000X
Internal Medicine Physician
125.070725
IL
Other
Enumeration date
04/10/2017
Last updated
08/31/2021
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