Provider Demographics
NPI:1356802201
Name:SURAPANENI, PHANI KEERTHI (MD)
Entity type:Individual
Prefix:
First Name:PHANI KEERTHI
Middle Name:
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 PIERCE ST STE 414
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3755
Mailing Address - Country:US
Mailing Address - Phone:712-220-6634
Mailing Address - Fax:712-220-6640
Practice Address - Street 1:2800 PIERCE ST STE 414
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3755
Practice Address - Country:US
Practice Address - Phone:712-220-6634
Practice Address - Fax:712-220-6640
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-51150207RA0000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program