Provider Demographics
NPI:1770533952
Name:JAGARLAPUDI, SIVA PRASAD (MD)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:PRASAD
Last Name:JAGARLAPUDI
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 1:411 LAUREL ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3026
Mailing Address - Country:US
Mailing Address - Phone:515-280-4700
Mailing Address - Fax:515-280-4701
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-280-4700
Practice Address - Fax:515-280-4701
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29097207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1770533952OtherWELLMARK BCBS
IAP00329641OtherRAILROAD MEDICARE
IA1770533952Medicaid
IAIB1540003Medicare PIN
IAI-17642Medicare PIN
IA1770533952OtherWELLMARK BCBS
IAE99536Medicare UPIN