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NPI Code Detail

MEDICARE: KUNAL K PATRA M.D.

MEDICARE: KUNAL K PATRA M.D.
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
12084P0800XPsychiatry Physician35203IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00150357OTHERMEDICARE ID UNSPECIFIED

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366402505
Entity Type Code : Individual
Provider Name (Legal Business Name) : KUNAL K PATRA M.D.
Provider Business Mailing Address
First Line : PO BOX 5427
Second Line :
City : SIOUX CITY
State : IA
Zip : 51102-5427
Country : US
Telephone Number : 712-274-6729
Fax Number : 712-274-6744
Provider Business Practice Location Address
First Line : 3549 SOUTHERN HILLS DR
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-4736
Country : US
Telephone Number : 712-274-6729
Fax Number : 712-274-6744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 04/09/2008

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Directions to “ KUNAL K PATRA M.D.” Practice Location

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