Hanumantha Rao Kolusu, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

31016 Issued in IA

Practice address

609 35TH Ave Ste 1a
Moline, IL 61265-6146

Phone

(563) 243-2022

Fax

(563) 243-4070

NPI assigned

Mar 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1831159409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 35TH AVE STE 1A",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656146",
            "telephone_number": "563-243-2022",
            "fax_number": "563-243-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 35TH AVE STE 1A",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656146",
            "telephone_number": "563-243-2022",
            "fax_number": "563-243-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLUSU",
        "first_name": "HANUMANTHA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "31016",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "31016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134767",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Kline
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• Internal Medicine Physician in Moline, IL
• Providers in Moline, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.