Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DR.0053903 | CO |
Y | 111NI0900X | Internist | DR.0053903 | CO |
N | 207RG0300X | Geriatric Medicine | DR.0053903 | CO |
NPI | 1023313764 |
---|---|
Provider Name | Vinod Krishnahari Gundu |
First Address | Pueblo, CO 81004-3733 |
Second Address | Pueblo, CO 81004-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2011 |
Last Update Date | 30/03/2015 |