KONDA BC MOULI, MD PC (NPI# 1376721035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376721035 |
| Entity Type | Organization |
| Organization Name | KONDA BC MOULI, MD PC |
| Practice Address |
777 Kimole Ln Suite 260 Adrian MI 49221-1478 |
| Practice Telephone | 5172654770 |
| Mailing Telephone | 5172654770 |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2008-11-25 |
| Authorized Official Name | JULIE HOLDRIDGE (BILLING SPECIALIST) |
| Authorized Official Telephone | 5172650229 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM | 340D610140 | 01 |
| Street Address |
777 KIMOLE LN SUITE 260 |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-1478 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972501138 | Heidi Nichols | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2005-07-12 |
| 1023470614 | Emily Grace Corfman | Speech-Language Pathologist | 777 Kimole Ln, Suite 110, Adrian, MI 49221-1478 | 2016-03-23 |
| 1083098420 | Sarah Farmer | Nurse Practitioner | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2015-07-15 |
| 1194096693 | Promedica Central Physicians | Internal Medicine | 777 Kimole Ln, Suite 250, Adrian, MI 49221-1478 | 2012-01-16 |
| 1689863391 | Anne Elisabeth Butts | Nurse Practitioner | 777 Kimole Ln, Ste. 260, Adrian, MI 49221-1478 | 2007-10-18 |
| 1285826008 | Annemarie Marwitz Kallenbach | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2007-08-15 |
| 1790812907 | Promedica Corporation of Michigan | Family Medicine | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2007-02-27 |
| 1336276542 | Promedica Corporation of Michigan | Otolaryngology | 777 Kimole Ln, Suite 240, Adrian, MI 49221-1478 | 2007-02-27 |
| 1093840381 | Promedica Corporation of Michigan | Surgery | 777 Kimole Ln, Suite 220, Adrian, MI 49221-1478 | 2007-02-23 |
| 1255483038 | Toledo Clinic Incorporated | Durable Medical Equipment & Medical Supplies | 777 Kimole Ln, Suite 130, Adrian, MI 49221-1478 | 2007-01-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
| Find all providers in zip 49221 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043419591 | Thomas K Mathew | Urology | 1245 Berkshire Ct, Adrian, MI 49221-1367 | 2007-07-15 |
| 1154353076 | Jonathan D Herschman | Urology | 777 Kimole Ln Ste 260, Adrian, MI 49221-1400 | 2006-07-07 |
| 1124087143 | Konda Bc Mouli | Urology | 777 Kimole Ln, Suite 260, Adrian, MI 49221-1478 | 2006-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477488 | Munson Healthcare Charlevoix Hospital | Urology | 11695 Park Ave, Suite A, Charlevoix, MI 49720 | 2020-11-06 |
| 1396235610 | Munson Medical Center | Urology | 405 N Division Rd Ste 2, Petoskey, MI 49770-9046 | 2018-05-11 |
| 1770072498 | Bellin Health Iron Mountain Inc | Urology | 1005 S Hemlock St Ste B, Iron Mountain, MI 49801-3854 | 2018-05-08 |
| 1205215621 | Alexander David Tapper | Urology | 44200 Woodward Ave Ste 207, Pontiac, MI 48341-5045 | 2015-05-19 |
| 1912324211 | Boston Medical Group, P.C. | Urology | 24901 Northwestern Hwy., Suite 615, Southfield, MI 48075 | 2014-03-25 |
| 1548600984 | Katie Marie Rosen | Urology | 19991 Hall Rd Ste 201, Macomb, MI 48044 | 2013-06-30 |
| 1609213636 | Arya Khatiwoda | Urology | 2900 Hannah Blvd Ste 104, East Lansing, MI 48823-5380 | 2013-05-31 |
| 1003179730 | Kalen Jacob Rimar | Urology | 130 Town Center Dr Ste 101, Troy, MI 48084 | 2012-06-18 |
| 1780955294 | Harry Nicholas Kotsis | Urology | 265 Touraine Rd, Grosse Pointe Farms, MI 48236-3308 | 2012-01-16 |
| 1750678264 | Michael Kozminski | Urology | 245 Cherry St Se Ste 202, Grand Rapids, MI 49503-4607 | 2011-07-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.