Provider Demographics
NPI:1861583064
Name:PATTANSHETTI, ISHVAR B (MD)
Entity type:Individual
Prefix:
First Name:ISHVAR
Middle Name:B
Last Name:PATTANSHETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2979 VICTORIA ST
Mailing Address - Street 2:VA CLINIC
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-332-8528
Mailing Address - Fax:563-332-9337
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:VA CLINIC
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:563-332-9331
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMI4301056915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine