Provider Demographics
NPI:1245222041
Name:KRESOWIK, TIMOTHY F (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:KRESOWIK
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:319-356-7976
Mailing Address - Fax:319-384-6306
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
Practice Address - Country:US
Practice Address - Phone:319-356-7976
Practice Address - Fax:319-384-6306
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-265712086S0129X
IA26571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0261362Medicaid
IA26136OtherWELLMARCK BCBS
IA26136Medicare PIN
IA26136OtherWELLMARCK BCBS