Provider Demographics
NPI:1053349167
Name:RAMESH, PRADEEP MANJANBAIL (MD)
Entity type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:MANJANBAIL
Last Name:RAMESH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4205 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7542
Mailing Address - Country:US
Mailing Address - Phone:319-553-2297
Mailing Address - Fax:319-553-2297
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3838
Practice Address - Fax:319-235-5272
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA37071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1053349167Medicaid
IA57177OtherWELLMARK
IA0076372Medicaid
IA57177OtherWELLMARK