MEDICARE: RAVINDRA MALLAVARAPU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD-34574	IA

General Provider Information

NPI Number	:	1982657961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVINDRA MALLAVARAPU MD

Provider Business Mailing Address
First Line	:	PO BOX 2758
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50704-2758
Country	:	US
Telephone Number	:	319-235-5390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 S HACKETT RD
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50701-3500
Country	:	US
Telephone Number	:	319-234-5990
Fax Number	:	319-234-5994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/28/2024

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