Individual
PHANI KEERTHI SURAPANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2800 PIERCE ST STE 414, SIOUX CITY, IA 51104-3755
(712) 220-6634
(712) 220-6640
Mailing address
2800 PIERCE ST STE 414, SIOUX CITY, IA 51104-3755
(712) 220-6634
(712) 220-6640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD-51150
IA
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
MD-51150
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2019
Last updated
06/01/2023
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