Healthcare Provider Details

I. General information

NPI: 1538726617
Provider Name (Legal Business Name): MOHAMMAD ATEF KOTOB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-353-6360
  • Fax: 319-353-7006
Mailing address:
  • Phone: 319-353-6360
  • Fax: 319-353-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberMD-47988
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-47988
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: