Healthcare Provider Details

I. General information

NPI: 1033418843
Provider Name (Legal Business Name): RANDHIR JESUDOSS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR JCP 4547
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR JCP 4547
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-4901
  • Fax: 319-384-8559
Mailing address:
  • Phone: 319-356-4901
  • Fax: 319-384-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberMD41902
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberMA41902
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD41902
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: