Provider Demographics
NPI:1366916371
Name:IOWA DERMATOLOGY CLINIC, PLC
Entity type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-226-3116
Mailing Address - Street 1:3720 N ANKENY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4605
Mailing Address - Country:US
Mailing Address - Phone:515-965-6839
Mailing Address - Fax:
Practice Address - Street 1:3720 N ANKENY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4605
Practice Address - Country:US
Practice Address - Phone:515-965-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty