Healthcare Provider Details

I. General information

NPI: 1255320511
Provider Name (Legal Business Name): SREENIVAS CHINTALAPANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 UTICA RIDGE RD SUITE 100
DAVENPORT IA
52807-3480
US

IV. Provider business mailing address

5041 UTICA RIDGE RD SUITE 100
DAVENPORT IA
52807-3480
US

V. Phone/Fax

Practice location:
  • Phone: 563-359-9696
  • Fax: 563-359-1730
Mailing address:
  • Phone: 563-359-9696
  • Fax: 563-359-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31406
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036093942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: