Provider Demographics
NPI:1104389790
Name:SONI, KARAN (MD)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4915
Mailing Address - Fax:515-643-8804
Practice Address - Street 1:1350 DES MOINES ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5507
Practice Address - Country:US
Practice Address - Phone:515-643-4915
Practice Address - Fax:515-643-8804
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-11-13
Deactivation Date:2020-01-30
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-509312086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program