Individual
HRIDENDRA N BASU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
146 W DALE ST, SUITE 201, WATERLOO, IA 50703-1901
(319) 234-4431
(319) 235-5004
Mailing address
146 W DALE ST, SUITE 201, WATERLOO, IA 50703-1901
(319) 234-4431
(319) 235-5004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19212
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0121236
—
IA
01
—
110115793
RR MEDICARE
IA
05
—
1366428559
—
IA
Enumeration date
12/20/2005
Last updated
05/17/2012
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