Provider Demographics
NPI:1518040534
Name:KASINATHAN, SRIRANJANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIRANJANI
Middle Name:
Last Name:KASINATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAJI
Other - Middle Name:
Other - Last Name:KASINATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:803 S GREENE ST
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1948
Mailing Address - Country:US
Mailing Address - Phone:712-472-3716
Mailing Address - Fax:712-472-2878
Practice Address - Street 1:803 S GREENE ST
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1948
Practice Address - Country:US
Practice Address - Phone:712-472-3716
Practice Address - Fax:712-472-2878
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1482695Medicaid
IA0482695Medicaid
IA0638700Medicaid
IA0250498Medicaid
IA0638700Medicaid
IAI5034Medicare ID - Type UnspecifiedPART B GROUP #
IA0482695Medicaid
IA1482695Medicaid