Basic Information
| Provider Information | |||||||||
| NPI: | 1396738282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONDI | ||||||||
| FirstName: | RAMA | ||||||||
| MiddleName: | K | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11125 DUNN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395522 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Practice Location | |||||||||
| Address1: | 11125 DUNN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395522 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036109540 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 2003012641 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 021291 | 01 | FMH | OTHER | 566489 | 01 | HEALTHLINK | OTHER | P00341379 | 01 | IL | ILRRMCR | OTHER | 8029043 | 01 | CIGNA | OTHER | 7471506 | 01 | AETNA | OTHER | 000000012077 | 01 | ESSENCE | OTHER | 195651 | 01 | BLUE CHOICE | OTHER | 021291 | 01 | JFMOLLOY | OTHER | 195651 | 01 | MO | MO BC/BS | OTHER | 2299725 | 01 | UHC | OTHER | H86336 | 01 | MERCY | OTHER | 208998823 | 05 | MO | MEDICAID | 231679 | 01 | GHP | OTHER | C50434 | 01 | MO | MORRMCR | OTHER |