Healthcare Provider Details

I. General information

NPI: 1255561023
Provider Name (Legal Business Name): DEEPTI SMITHA KURRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 7TH AVE STE B
MARION IA
52302
US

IV. Provider business mailing address

2996 7TH AVE STE B
MARION IA
52302-3713
US

V. Phone/Fax

Practice location:
  • Phone: 319-377-4844
  • Fax: 319-377-0852
Mailing address:
  • Phone: 319-377-4844
  • Fax: 319-377-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39953
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: