Provider Demographics
NPI:1043202419
Name:AMENDOLA, ANNUNZIATO (MD)
Entity Type:Individual
Prefix:
First Name:ANNUNZIATO
Middle Name:
Last Name:AMENDOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4230
Mailing Address - Fax:319-353-6754
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4230
Practice Address - Fax:319-353-6754
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34180207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0242644Medicaid
IA41987OtherWELLMARK BCBS
IA0242644Medicaid
IA41987OtherWELLMARK BCBS
H52522Medicare UPIN