Basic Information
Provider Information | |||||||||
NPI: | 1952501918 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TANDON | ||||||||
FirstName: | HIMANSHU | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4150 KIMBALL AVE | ||||||||
Address2: | PO BOX 2758 | ||||||||
City: | WATERLOO | ||||||||
State: | IA | ||||||||
PostalCode: | 507019086 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3192355390 | ||||||||
FaxNumber: | 3192355607 | ||||||||
Practice Location | |||||||||
Address1: | 419 E DONALD ST | ||||||||
Address2: |   | ||||||||
City: | WATERLOO | ||||||||
State: | IA | ||||||||
PostalCode: | 507031500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3192361911 | ||||||||
FaxNumber: | 3192875832 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2007 | ||||||||
LastUpdateDate: | 03/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 39996 | IA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RC0000X | 39996 | IA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.