Basic Information
| Provider Information | |||||||||
| NPI: | 1003070921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLAKALA | ||||||||
| FirstName: | NEETHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9943 HICKMAN RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503225304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152481447 | ||||||||
| FaxNumber: | 5152481440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152481500 | ||||||||
| FaxNumber: | 5152481510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | R8274 | IA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 39219 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.