Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-08-27
- Last updated
- 2024-05-20
Licenses
- License KS
- 04-38088
- License IA
- 34730
Location
- Practice location
- 1519 S PHILLIPS ST
- City
- ALGONA IA
- Postal code
- 505113649
- Phone
- 515-295-7714
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.