Individual
DR. NAGENDRA V MYNENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1378 NW 124TH ST, SUITE 200, CLIVE, IA 50325-8151
(515) 288-6097
(515) 288-6099
Mailing address
1378 NW 124TH ST, SUITE 200, CLIVE, IA 50325-8151
(515) 288-6097
(515) 288-6099
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
35292
IA
207RG0100X
Gastroenterology Physician
72285
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0422428
—
IA
Enumeration date
05/02/2006
Last updated
11/04/2024
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