Healthcare Provider Details

I. General information

NPI: 1407882277
Provider Name (Legal Business Name): ASHOK K NAKHASI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR SUITE # 302
WATERLOO IA
50702-5619
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR SUITE # 302
WATERLOO IA
50702-5619
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8644
  • Fax: 319-272-8637
Mailing address:
  • Phone: 319-272-8644
  • Fax: 319-272-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number22709
License Number StateIA

VIII. Authorized Official

Name: DR. ASHOK K NAKHASI
Title or Position: OWNER
Credential: M.D.
Phone: 319-272-8644