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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