Provider Demographics
NPI:1326327149
Name:KOLWADKAR, YOGESH VINOD (MD,MRCSED,MS,MCH)
Entity Type:Individual
Prefix:DR
First Name:YOGESH
Middle Name:VINOD
Last Name:KOLWADKAR
Suffix:
Gender:M
Credentials:MD,MRCSED,MS,MCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 6TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3901
Mailing Address - Country:US
Mailing Address - Phone:712-580-2022
Mailing Address - Fax:
Practice Address - Street 1:20 W 6TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3901
Practice Address - Country:US
Practice Address - Phone:712-580-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36668207X00000X
IAMD-42289207X00000X
PAMT202820207XX0005X
IL125.059018207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI113010004OtherMEDICARE
IAI113010004OtherMEDICARE