Provider Demographics
NPI:1154318400
Name:MEDICI FEICK, DEBORAH L (PAC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MEDICI FEICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-465-3553
Mailing Address - Fax:515-465-4319
Practice Address - Street 1:616 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2221
Practice Address - Country:US
Practice Address - Phone:515-465-3553
Practice Address - Fax:515-465-4319
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970031153OtherRR MEDICARE
IAI8388Medicare PIN
IA970031153OtherRR MEDICARE