Healthcare Provider Details

I. General information

NPI: 1891782553
Provider Name (Legal Business Name): VENKATESWARA R KARUPARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 25TH ST STE D
ROCK ISLAND IL
61201-5419
US

IV. Provider business mailing address

PO BOX 850
MOLINE IL
61266-0850
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-7246
  • Fax: 309-762-7242
Mailing address:
  • Phone: 309-762-9711
  • Fax: 309-762-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34461
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34461
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: