Individual
MRS. SHOBHA RANI CHITNENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1351 KIMBERLY RD, STE 100, BETTENDORF, IA 52722-4193
(563) 355-7733
(563) 355-9077
Mailing address
1351 KIMBERLY RD, STE 100, BETTENDORF, IA 52722-4193
(563) 355-7733
(563) 355-9077
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
30086
IA
207RH0003X
Hematology & Oncology Physician
Primary
30086
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109777
—
IA
01
—
16362
WELLMARK BC BS
—
01
—
421423259
FEDERAL TAX IDENTIFICATIO
—
Enumeration date
03/24/2006
Last updated
12/14/2012
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