Provider Demographics
NPI:1801994421
Name:KONDA-SUNDHEIM, RACHEL IRENE (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:IRENE
Last Name:KONDA-SUNDHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N. BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-669-3298
Mailing Address - Fax:970-669-6244
Practice Address - Street 1:2021 N. BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-669-3298
Practice Address - Fax:970-669-6244
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97185868Medicaid
COCOA103081Medicare PIN