Healthcare Provider Details

I. General information

NPI: 1407003015
Provider Name (Legal Business Name): MURALI KRISHNA SURNEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

PO BOX 2758 4150 KIMBALL AVENUE
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3716
  • Fax: 319-235-5202
Mailing address:
  • Phone: 319-235-5390
  • Fax: 319-235-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberP3082
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: