Provider Demographics
NPI:1326043514
Name:KANATHUR, NAVEEN R (MD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:R
Last Name:KANATHUR
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 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5250
Mailing Address - Fax:563-742-5255
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5250
Practice Address - Fax:563-742-5255
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040317207RP1001X
IA41197207RP1001X
IL036.133781207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01362492OtherRR MEDICARE
ILP01362487OtherRR MEDICARE
ILF400105271Medicare PIN
CTI04250Medicare UPIN
ILP01362487OtherRR MEDICARE