Provider Demographics
NPI:1508811258
Name:KANTAMNENI, VINAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:KUMAR
Last Name:KANTAMNENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5940
Mailing Address - Fax:319-833-5941
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 105
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-833-5940
Practice Address - Fax:319-833-5941
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA32046207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0157628Medicaid
IA40362OtherWELLMARK INS PLAN
IA424417307A9OtherJOHN DEERE HEALTH INS PLA
IA40362OtherWELLMARK INS PLAN
E96195Medicare UPIN