Provider Demographics
NPI:1720475403
Name:KUNDUMADAM, SHANKER DAS (MD)
Entity Type:Individual
Prefix:MR
First Name:SHANKER DAS
Middle Name:
Last Name:KUNDUMADAM
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:MERCY GASTROENTEROLOGY CLINIC
Mailing Address - Street 2:788 8TH AVENUE SE, SUITE 300
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401
Mailing Address - Country:US
Mailing Address - Phone:319-369-4542
Mailing Address - Fax:319-369-4543
Practice Address - Street 1:MERCY GASTROENTEROLOGY CLINIC
Practice Address - Street 2:788 8TH AVENUE SE, SUITE 300
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401
Practice Address - Country:US
Practice Address - Phone:319-369-4542
Practice Address - Fax:319-369-4543
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2022-08-11
Deactivation Date:2015-11-24
Deactivation Code:
Reactivation Date:2015-12-22
Provider Licenses
StateLicense IDTaxonomies
IAMD-49141207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology