Provider Demographics
NPI:1528056470
Name:MIMURA, HIDEFUMI (MD)
Entity type:Individual
Prefix:
First Name:HIDEFUMI
Middle Name:
Last Name:MIMURA
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:UNIVERSITY OF IOWA HOSPITALS & CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1071
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:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1071
Practice Address - Fax:319-356-2220
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASP 1622085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0459081Medicaid
IA38548OtherWELLMARK BCBS
I27840Medicare UPIN
IAI14974Medicare ID - Type Unspecified