Healthcare Provider Details

I. General information

NPI: 1952721409
Provider Name (Legal Business Name): DILLI RAJ BHURTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE 310
CEDAR RAPIDS IA
52402-5064
US

IV. Provider business mailing address

855 A AVE NE STE 310
CEDAR RAPIDS IA
52402-5064
US

V. Phone/Fax

Practice location:
  • Phone: 319-558-4951
  • Fax: 319-558-4592
Mailing address:
  • Phone: 319-558-4951
  • Fax: 319-558-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD-44186
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: