1154355840 NPI number — NAGARATHNAMMA NADIPURAM, MD, PLC

Table of content: SUSAN JEAN BROTT P.T. (NPI 1336330331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154355840 NPI number — NAGARATHNAMMA NADIPURAM, MD, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAGARATHNAMMA NADIPURAM, MD, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154355840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50704-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-233-3044
Provider Business Mailing Address Fax Number:
319-233-0722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 W DALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50703-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-235-3178
Provider Business Practice Location Address Fax Number:
319-274-6776
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NADIPURAM
Authorized Official First Name:
NAGARATHNAMMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
319-235-3178

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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