Provider Demographics
NPI:1649702218
Name:KONDAJJI, ABHIRAM MALATHESHA (DO, MS)
Entity type:Individual
Prefix:DR
First Name:ABHIRAM
Middle Name:MALATHESHA
Last Name:KONDAJJI
Suffix:
Gender:M
Credentials:DO, MS
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Other - First Name:
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Mailing Address - Street 1:12300 MCCRACKEN RD STE 450
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2975
Mailing Address - Country:US
Mailing Address - Phone:216-518-3650
Mailing Address - Fax:
Practice Address - Street 1:12300 MCCRACKEN RD STE 450
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-518-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015591208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty