Basic Information
| Provider Information | |||||||||
| NPI: | 1598750507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALAPATI | ||||||||
| FirstName: | KISHORE | ||||||||
| MiddleName: | VENKATA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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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 | 208C00000X | 036114423 | IL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 36284 | IA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00298313 | 01 | IL | RAILROAD MEDICARE | OTHER | 36114423 | 05 | IL | MEDICAID |