Healthcare Provider Details

I. General information

NPI: 1427996404
Provider Name (Legal Business Name): NEW GI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S HACKETT RD
WATERLOO IA
50701-3543
US

IV. Provider business mailing address

1015 S HACKETT RD
WATERLOO IA
50701-3543
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-5990
  • Fax: 319-234-5994
Mailing address:
  • Phone: 319-234-5990
  • Fax: 319-234-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAVINDRA MALLAVARAPU
Title or Position: PRESIDENT
Credential: MD
Phone: 319-234-5990