1891782553 NPI number — VENKATESWARA R KARUPARTHY MD

Table of content: VENKATESWARA R KARUPARTHY MD (NPI 1891782553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891782553 NPI number — VENKATESWARA R KARUPARTHY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARUPARTHY
Provider First Name:
VENKATESWARA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891782553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61266-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-762-9711
Provider Business Mailing Address Fax Number:
309-762-9747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2508 25TH ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-762-7246
Provider Business Practice Location Address Fax Number:
309-762-7242
Provider Enumeration Date:
09/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  34461 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 34461 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44548 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2258764 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0258764 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92920 . This is a "BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 08132073 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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