Healthcare Provider Details

I. General information

NPI: 1619162435
Provider Name (Legal Business Name): PRAVEEN VIKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MAIN ST MCCREERY CANCER CENTER
FAIRFIELD IA
52556-9572
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1007
US

V. Phone/Fax

Practice location:
  • Phone: 641-472-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39452
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number39452
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: