Healthcare Provider Details

I. General information

NPI: 1528053840
Provider Name (Legal Business Name): ROHINI REGANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE SUITE 152
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

1225 S GEAR AVE SUITE 152
WEST BURLINGTON IA
52655-1691
US

V. Phone/Fax

Practice location:
  • Phone: 319-753-1220
  • Fax: 319-753-5464
Mailing address:
  • Phone: 319-753-1220
  • Fax: 319-753-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number23028
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: