Healthcare Provider Details

I. General information

NPI: 1487633087
Provider Name (Legal Business Name): MOHANA R VELAGAPUDI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

525 VALLEY VIEW DR
MOLINE IL
61265-6138
US

V. Phone/Fax

Practice location:
  • Phone: 309-764-5900
  • Fax: 309-764-5926
Mailing address:
  • Phone: 309-764-5900
  • Fax: 309-764-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: