Provider Demographics
NPI:1992795850
Name:CHUNDURI, JAIDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:JAIDEEP
Middle Name:
Last Name:CHUNDURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-7601
Practice Address - Street 1:6480 HARRISON AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-7601
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2366207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH82366OtherHUMANA
OHP00042913OtherRAILROAD MEDICARE
OH3207090OtherAETNA
OH409602OtherWELLCARE
IN200197870Medicaid
OH2412222Medicaid
OH000000287763OtherANTHEM
OH2412222Medicaid
OH3207090OtherAETNA
OH4111743Medicare PIN