Provider Demographics
NPI:1558359315
Name:MITROS, FRANK A (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:MITROS
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:319-356-1760
Mailing Address - Fax:319-384-8052
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:319-356-1760
Practice Address - Fax:319-384-8052
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20483207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33945OtherWELLMARK BCBS
IA0224246Medicaid
IA22424OtherWELLMARK BCBS
IA1224246Medicaid
IA33945OtherWELLMARK BCBS
A02602Medicare UPIN
IA0224246Medicaid
IA22424Medicare PIN