Active NPI
Carlos A Iwamoto, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Minneapolis, MN
National Provider Identifier
1699788125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 036-107062
- Practice address
- 1 Veterans Dr
Vamc - Pathology 113
Minneapolis, MN 55417-2309 - Phone
- (612) 467-2506
- Fax
- (612) 725-2079
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 036-107062 | IL | Primary |
Addresses
Primary practice location
1 Veterans Dr
Vamc - Pathology 113
Minneapolis, MN 55417-2309
Mailing address
1 Veterans Dr
Vamc - Pathology 113
Minneapolis, MN 55417-2309
Phone (612) 467-2506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-107062 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264809600000",
"number": "1699788125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 VETERANS DR",
"address_2": "VAMC - PATHOLOGY 113",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-467-2506",
"fax_number": "612-725-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 VETERANS DR",
"address_2": "VAMC - PATHOLOGY 113",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-467-2506",
"fax_number": "612-725-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IWAMOTO",
"first_name": "CARLOS",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2010-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IL",
"license": "036-107062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.