Provider Demographics
NPI:1407383870
Name:KERMANI, ATABAK ASVADI (MD)
Entity Type:Individual
Prefix:DR
First Name:ATABAK
Middle Name:ASVADI
Last Name:KERMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ATABAK
Other - Middle Name:
Other - Last Name:ASVADI KERMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1201 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4009
Mailing Address - Country:US
Mailing Address - Phone:319-730-7300
Mailing Address - Fax:319-730-7368
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:319-384-7560
Practice Address - Fax:614-412-2685
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine