Basic Information
| Provider Information | |||||||||
| NPI: | 1396078291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAVURAM | ||||||||
| FirstName: | SREECHARAN REDDY | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | DEPT OF INTERNAL MEDICINE | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193848506 | ||||||||
| FaxNumber: | 3193563086 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | DEPT OF INTERNAL MEDICINE | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193848506 | ||||||||
| FaxNumber: | 3193563086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 08/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2009020450 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 2009020450 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 41162 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.