MEDICARE: NAVEEN R KANATHUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	040317	CT
2	207RP1001X	Pulmonary Disease Physician	41197	IA
3	207RP1001X	Pulmonary Disease Physician	036.133781	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01362492	OTHER	IA	RR MEDICARE
2	P01362487	OTHER	IL	RR MEDICARE

General Provider Information

NPI Number	:	1326043514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVEEN R KANATHUR MD

Provider Business Mailing Address
First Line	:	4480 UTICA RIDGE RD
Second Line	:	SUITE 108
City	:	BETTENDORF
State	:	IA
Zip	:	52722-1656
Country	:	US
Telephone Number	:	563-742-5250
Fax Number	:	563-742-5255

Provider Business Practice Location Address
First Line	:	4480 UTICA RIDGE RD
Second Line	:	SUITE 108
City	:	BETTENDORF
State	:	IA
Zip	:	52722-1656
Country	:	US
Telephone Number	:	563-742-5250
Fax Number	:	563-742-5255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/05/2015

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Directions to “ NAVEEN R KANATHUR MD” Practice Location

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