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General NPI Number Information
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NPI Number | 1346243169
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Entity Type | Individual
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Provider Name | SAMUEL K APPAVU M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 2300 N ROCKTON AVE STE 304
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City | ROCKFORD
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State | IL
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Zip | 61103-3619
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Country | US
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Telephone | 815-964-3333
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Fax | 815-964-3134
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Provider Business Mailing Address
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Address Line | PO BOX 15730
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City | LOVES PARK
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State | IL
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Zip | 61132-5730
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Country | US
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Telephone | 815-964-3333
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Fax | 815-964-3134
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036048085
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036048085
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 036048085
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 036048085
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License Number State | IL
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