Healthcare Provider Details

I. General information

NPI: 1265421036
Provider Name (Legal Business Name): VENKATA RAJAMANNAR KOTHIMBAKAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR UNIVERSITY OF IOWA HOSPITALS & CLINICS
IOWA CITY IA
52242-1082
US

IV. Provider business mailing address

200 HAWKINS DR UNIVERSITY OF IOWA HOSPITALS & CLINICS
IOWA CITY IA
52242-1082
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-4329
  • Fax: 319-356-2220
Mailing address:
  • Phone: 319-356-4329
  • Fax: 319-356-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberSP171
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: