Provider Demographics
NPI:1316923311
Name:GERVICH, DANIEL H (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:GERVICH
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 1:1601 NW 114TH ST
Mailing Address - Street 2:STE 347
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-224-1777
Mailing Address - Fax:515-222-0226
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 347
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:515-224-1777
Practice Address - Fax:515-222-0226
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20448207RC0200X, 207RI0200X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Not Answered2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23898OtherMIDLAND'S CHOICE
IAIA0103OtherUHC OF THE RIVER VALLEY
IA15380OtherWELLMARK
IA849863OtherUHC
IA0153809Medicaid
IA72633OtherCOVENTRY
IA849863OtherUHC
IAIA0103OtherUHC OF THE RIVER VALLEY