Individual
DR. BALAKRISHNA MUNDODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 JOHN DEERE RD, MOLINE, IL 61265-6899
(309) 743-6700
(309) 764-2042
Mailing address
1236 E RUSHOLME ST, SUITE 300, DAVENPORT, IA 52803-2473
(563) 324-2992
(563) 324-8562
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036066456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066456
—
IL
01
—
060051143
MEDICARE RAILROAD
—
05
—
1955849
—
IA
Enumeration date
01/10/2006
Last updated
07/29/2013
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