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Organization
QUAD CITIES NEPHROLOGY ASSOCIATES, P.L.C., LLC
Active
Organization
QUAD CITIES NEPHROLOGY ASSOCIATES, P.L.C., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATESWARARAO ALLA M.D. (MEDICAL DIRECTOR)
(309) 517-3036
Entity
Organization
Contact information
Practice address
400 JOHN DEERE RD BLDG 1, MOLINE, IL 61265-6898
(309) 517-3036
(309) 797-1088
Mailing address
400 JOHN DEERE RD BLDG 1, MOLINE, IL 61265-6898
(309) 517-3036
(309) 797-1088
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0175471
—
IA
05
—
036056049
—
IL
05
—
036088655
—
IL
05
—
036103114
—
IL
05
—
036114547
—
IL
05
—
0510917
—
IA
01
—
08100343
BCBS ILLINOIS
IL
01
—
56266
WELLMARK
IA
01
—
93122
WELLMARK ILLINOIS
IA
01
—
DG2517
RR GP RA ONLY
IL
Enumeration date
12/06/2006
Last updated
06/21/2016
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