Provider Demographics
NPI:1851515688
Name:KEERAN, SANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTHI
Middle Name:
Last Name:KEERAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANTHI
Other - Middle Name:
Other - Last Name:ILANKEERAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 S HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3500
Mailing Address - Country:US
Mailing Address - Phone:319-274-1000
Mailing Address - Fax:319-292-6526
Practice Address - Street 1:1015 S HACKETT RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3500
Practice Address - Country:US
Practice Address - Phone:319-274-1000
Practice Address - Fax:319-292-6526
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA38555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1851515688Medicaid
IAP00914938OtherRR MEDICARE
0-619-248-8OtherECFMG
IACC6519OtherRR MEDICARE
IA1851515688Medicaid