Provider Demographics
NPI:1962444349
Name:NADIPURAM, MUKUND G (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKUND
Middle Name:G
Last Name:NADIPURAM
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2101 KIMBALL AVE # LL14
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:200 E RIDGEWAY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5060
Practice Address - Country:US
Practice Address - Phone:319-272-2070
Practice Address - Fax:319-272-2077
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA26821207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1052365Medicaid
IA58745Medicare PIN
IAA64185Medicare UPIN