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NPI Code Detail

MEDICARE: DR. PRAKASH R BONTU M.D.

MEDICARE: DR. PRAKASH R BONTU 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
1207RC0000XCardiovascular Disease Physician24121IA

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 : 1912986837
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRAKASH R BONTU M.D.
Provider Business Mailing Address
First Line : 1236 E RUSHOLME ST
Second Line : SUITE 300
City : DAVENPORT
State : IA
Zip : 52803-2473
Country : US
Telephone Number : 563-324-2992
Fax Number : 563-888-0499
Provider Business Practice Location Address
First Line : 1236 E RUSHOLME ST
Second Line : SUITE 300
City : DAVENPORT
State : IA
Zip : 52803-2473
Country : US
Telephone Number : 563-324-2992
Fax Number : 563-888-0499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2006
Last Update Date : 11/21/2007

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Directions to “ DR. PRAKASH R BONTU M.D.” Practice Location

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