Healthcare Provider Details

I. General information

NPI: 1790209914
Provider Name (Legal Business Name): KIRON VISWAMBHARAN NAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 C AVE E
OSKALOOSA IA
52577-4298
US

IV. Provider business mailing address

1229 C AVE E
OSKALOOSA IA
52577-4298
US

V. Phone/Fax

Practice location:
  • Phone: 641-672-3236
  • Fax:
Mailing address:
  • Phone: 641-672-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD-54987
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2021040912
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: