Healthcare Provider Details

I. General information

NPI: 1871113233
Provider Name (Legal Business Name): KAUSHIK DARBHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 07/12/2024
Certification Date: 01/10/2022
Deactivation Date: 01/10/2022
Reactivation Date: 07/12/2024

III. Provider practice location address

250 S CRESCENT DRIVE SUITE M2600
MASON CITY IA
50401-2926
US

IV. Provider business mailing address

250 S CRESCENT DRIVE
MASON CITY IA
50401-2926
US

V. Phone/Fax

Practice location:
  • Phone: 641-494-5300
  • Fax: 641-494-5329
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD53148
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: