Basic Information
| Provider Information | |||||||||
| NPI: | 1417343971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONDE | ||||||||
| FirstName: | ANISH | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4525 3RD AVE SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985031010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607543934 | ||||||||
| FaxNumber: | 3609438023 | ||||||||
| Practice Location | |||||||||
| Address1: | 4525 3RD AVE SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985031010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607543934 | ||||||||
| FaxNumber: | 3609438023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2015 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD61187142 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | MD61187142 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.