Provider Demographics
NPI:1285601641
Name:KAMALA, JERUSA (MD)
Entity type:Individual
Prefix:DR
First Name:JERUSA
Middle Name:
Last Name:KAMALA
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 1:1250 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2316
Mailing Address - Country:US
Mailing Address - Phone:515-263-2600
Mailing Address - Fax:515-263-2620
Practice Address - Street 1:1250 9TH STREET
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2765
Practice Address - Country:US
Practice Address - Phone:515-263-2600
Practice Address - Fax:515-263-2620
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0284695Medicaid
IA1285601641Medicaid
IA0284695Medicaid
IA1285601641Medicaid
IA0284695Medicaid