Provider Demographics
NPI:1891782553
Name:KARUPARTHY, VENKATESWARA R (MD)
Entity Type:Individual
Prefix:
First Name:VENKATESWARA
Middle Name:R
Last Name:KARUPARTHY
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 850
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0850
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-762-9747
Practice Address - Street 1:2508 25TH ST STE D
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5419
Practice Address - Country:US
Practice Address - Phone:309-762-7246
Practice Address - Fax:309-762-7242
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34461207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44548OtherWELLMARK BCBS
IA2258764Medicaid
IA0258764Medicaid
IA92920OtherBLUE SHIELD
IL08132073OtherBLUE SHIELD
IAI5804Medicare PIN
IA44548OtherWELLMARK BCBS
P00321982Medicare PIN
ILK23924Medicare PIN
IA0258764Medicaid