MEDICARE: THOMAS JOB MUKKADA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	28127	IA

General Provider Information

NPI Number	:	1518961036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOB MUKKADA MD

Provider Business Mailing Address
First Line	:	312 E ALTA VISTA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-1413
Country	:	US
Telephone Number	:	641-682-4115
Fax Number	:	641-682-0005

Provider Business Practice Location Address
First Line	:	312 E ALTA VISTA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-1413
Country	:	US
Telephone Number	:	641-682-4115
Fax Number	:	641-682-0005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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