Healthcare Provider Details

I. General information

NPI: 1972533040
Provider Name (Legal Business Name): DODGE STREET ANESTHESIOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI STREET SUITE 300
DUBUQUE IA
52001-6320
US

IV. Provider business mailing address

1515 DELHI STREET SUITE 300
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-8500
  • Fax: 563-589-4078
Mailing address:
  • Phone: 563-557-8500
  • Fax: 563-589-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SUDHIR KONERU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 563-557-8500