Provider Demographics
NPI:1902885445
Name:MOTWANI, BHARAT A (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:A
Last Name:MOTWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-421-4244
Mailing Address - Fax:563-421-4249
Practice Address - Street 1:1228 E RUSHOLME ST STE 3060
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2453
Practice Address - Country:US
Practice Address - Phone:563-421-4244
Practice Address - Fax:563-421-4249
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109310208M00000X
IA36006207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0472365Medicaid
IAI17989127Medicare PIN
IA0472365Medicaid
IL213907037Medicare PIN
IA1241762OtherCONTROLLED SUBSTANCE #
IA421060724B6OtherJOHN DEERE HEALTH
IA110064OtherHEALTH ALLIANCE #
IA36006OtherIOWA STATE LICENSE
IABM9379858OtherFEDERAL DEA#
IAIA0B6OtherJOHNE DEERE EDI#
IAI16012Medicare ID - Type UnspecifiedIOWA MEDICARE PART B
IA01688OtherIOWA BC/BS
IA247654OtherMIDLAND'S CHOICEE
IL8122859OtherILLINOIS BC/BS
IA161822Medicare ID - Type UnspecifiedMEDICARE UGS