Provider Demographics
NPI:1124090980
Name:KAMAL, GAGAN DEEP (MD)
Entity type:Individual
Prefix:MR
First Name:GAGAN
Middle Name:DEEP
Last Name:KAMAL
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 1:540 E JEFFERSON ST
Mailing Address - Street 2:STE 106
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2479
Mailing Address - Country:US
Mailing Address - Phone:319-354-2653
Mailing Address - Fax:319-339-1364
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2689
Practice Address - Country:US
Practice Address - Phone:319-354-2653
Practice Address - Fax:319-339-1364
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26117207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1252338Medicaid
IA40923Medicare ID - Type Unspecified
IAI14326Medicare PIN
IA1252338Medicaid