Provider Demographics
NPI:1609840834
Name:CHELLI, NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:CHELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAOMI
Other - Middle Name:CHELLI
Other - Last Name:GUNTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3135 52ND AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6953
Mailing Address - Country:US
Mailing Address - Phone:563-355-8297
Mailing Address - Fax:
Practice Address - Street 1:3540 E 46TH ST
Practice Address - Street 2:CONCENTRA
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3403
Practice Address - Country:US
Practice Address - Phone:563-359-1170
Practice Address - Fax:563-359-3828
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1561365Medicaid
IL362739299-52807-01Medicaid
IA1561365Medicaid