Provider Demographics
NPI:1265421036
Name:KOTHIMBAKAM, VENKATA RAJAMANNAR (MD)
Entity type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAJAMANNAR
Last Name:KOTHIMBAKAM
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS & CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1082
Mailing Address - Country:US
Mailing Address - Phone:319-356-4329
Mailing Address - Fax:319-356-2220
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:UNIVERSITY OF IOWA HOSPITALS & CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1082
Practice Address - Country:US
Practice Address - Phone:319-356-4329
Practice Address - Fax:319-356-2220
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IASP1712085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0455485Medicaid
IA37936OtherWELLMARK BCBS
IAI14715Medicare ID - Type Unspecified
I25809Medicare UPIN