Provider Demographics
NPI:1154559920
Name:TODT, DOROTHY J (MD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:TODT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 SUNNYBROOK DR
Mailing Address - Street 2:SUITE E-100
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4203
Mailing Address - Country:US
Mailing Address - Phone:712-266-2700
Mailing Address - Fax:712-266-2759
Practice Address - Street 1:5885 SUNNYBROOK DR
Practice Address - Street 2:SUITE E-100
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4203
Practice Address - Country:US
Practice Address - Phone:712-266-2700
Practice Address - Fax:712-266-2759
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD40401207Q00000X
IA40401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA00606Medicaid
IA219640019Medicare PIN