Provider Demographics
NPI:1003923467
Name:ATRE STRAND, DEEPTA SHANKAR (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTA
Middle Name:SHANKAR
Last Name:ATRE STRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPTA
Other - Middle Name:SHANKAR
Other - Last Name:ATRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:354 FERSON AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3510
Mailing Address - Country:US
Mailing Address - Phone:319-341-4245
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5351
Practice Address - Country:US
Practice Address - Phone:309-779-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48566207P00000X
IL036-123193207P00000X
IA36939207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00741037OtherRR MEDICARE
IA54454011Medicare PIN
IL813590006Medicare PIN