Individual
DR. RAVINDRAKUMAR GANGADHARIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4624 PROGRESS DRIVE STE D, DAVENPORT, IA 52807
(563) 355-0015
(563) 355-0013
Mailing address
4624 PROGRESS DRIVE STE D, DAVENPORT, IA 52807
(563) 355-0015
(563) 355-0013
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036-115671
IL
207N00000X
Dermatology Physician
Primary
36638
IA
207R00000X
Internal Medicine Physician
036115671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115671
—
IL
05
—
0744987
—
IA
Enumeration date
06/06/2006
Last updated
04/04/2019
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