Provider Demographics
NPI: | 1619223880 |
---|---|
Name: | MISHRA, ANKUR (MBBS) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANKUR |
Middle Name: | |
Last Name: | MISHRA |
Suffix: | |
Gender: | M |
Credentials: | MBBS |
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: | DEPT OF INTERNAL MEDICINE SE611 GH |
Mailing Address - City: | IOWA CITY |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52242-1009 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-356-4019 |
Mailing Address - Fax: | 319-353-8073 |
Practice Address - Street 1: | 200 HAWKINS DR |
Practice Address - Street 2: | DEPT OF INTERNAL MEDICINE SE611 GH |
Practice Address - City: | IOWA CITY |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52242-1009 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-356-4019 |
Practice Address - Fax: | 319-353-8073 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-07-25 |
Last Update Date: | 2015-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | MD-42410 | 207R00000X, 207RA0000X, 207RA0201X, 207RB0002X, 207RC0000X, 207RI0001X, 207RC0001X, 207RC0200X, 207RE0101X, 207RG0100X, 207RG0300X, 207RH0000X, 207RH0003X, 207R00000X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | |
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RA0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No | 207RA0201X | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No | 207RB0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Obesity Medicine |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RI0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical & Laboratory Immunology |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |