Healthcare Provider Details

I. General information

NPI: 1104804053
Provider Name (Legal Business Name): WINTHROP S RISK II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 5TH AVE SE
CEDAR RAPIDS IA
52403-2421
US

IV. Provider business mailing address

811 5TH AVE SE
CEDAR RAPIDS IA
52403-2421
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-7924
  • Fax: 319-362-1435
Mailing address:
  • Phone: 319-362-7924
  • Fax: 319-362-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35883
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier38919
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK
# 2
IdentifierIA0111
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerHERITAGE
# 3
Identifier0450387
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: