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General NPI Number Information
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NPI Number | 1184684987
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Entity Type | Individual
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Provider Name | SHOBHA RANI CHITNENI M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 1351 KIMBERLY RD STE 100
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City | BETTENDORF
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State | IA
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Zip | 52722-4193
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Country | US
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Telephone | 563-355-7733
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Fax | 563-355-9077
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Provider Business Mailing Address
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Address Line | 1351 KIMBERLY RD STE 100
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City | BETTENDORF
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State | IA
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Zip | 52722-4193
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Country | US
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Telephone | 563-355-7733
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Fax | 563-355-9077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30086
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 30086
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License Number State | IA
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