Keith Robert Wolstenholme, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

R-8769 Issued in IA

Practice address

200 Hawkins Dr
Orthopaedic Surgery Department
Iowa City, IA 52242-1009

Phone

(319) 353-7954

Fax

(319) 384-9306

NPI assigned

Aug 18, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250553600000",
    "number": "1104058502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "address_2": "ORTHOPAEDIC SURGERY DEPARTMENT",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-353-7954",
            "fax_number": "319-384-9306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "address_2": "ORTHOPAEDIC SURGERY DEPARTMENT",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-353-7954",
            "fax_number": "319-384-9306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLSTENHOLME",
        "first_name": "KEITH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IA",
            "license": "R-8769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.