Provider Demographics
NPI:1366707242
Name:PACKIAM, VIGNESH THAMILARASU (MD)
Entity type:Individual
Prefix:DR
First Name:VIGNESH
Middle Name:THAMILARASU
Last Name:PACKIAM
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:319-356-2421
Mailing Address - Fax:319-356-3900
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:319-356-2421
Practice Address - Fax:319-356-3900
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63954208800000X
IAMD-46994207RX0202X, 208800000X
IL125-061212208800000X
WI69978208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology