Provider Demographics
NPI:1699744193
Name:RANGUELOV, ROSTISLAV DIMITROV (MD)
Entity type:Individual
Prefix:DR
First Name:ROSTISLAV
Middle Name:DIMITROV
Last Name:RANGUELOV
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-9609
Mailing Address - Fax:319-384-9613
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-9609
Practice Address - Fax:319-384-9613
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042071207ZP0102X
IAMD-49538207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8433286Medicaid
WA203956OtherLABOR & INDUSTRIES
I40844Medicare UPIN
WAG8861524Medicare PIN
WAG8855839Medicare PIN