Provider Demographics
NPI:1386654879
Name:BASTUG PLASTIC SURGERY PC
Entity type:Organization
Organization Name:BASTUG PLASTIC SURGERY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIZ
Authorized Official - Middle Name:F
Authorized Official - Last Name:BASTUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-272-8550
Mailing Address - Street 1:2710 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 419
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5634
Mailing Address - Country:US
Mailing Address - Phone:319-272-8550
Mailing Address - Fax:319-272-8558
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 419
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-8550
Practice Address - Fax:319-272-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1162420Medicaid
IA32236OtherMEDICAL LICENSE
IA249985OtherMIDLAND'S CHOICE
IAIA0101OtherJOHN DEERE HEALTH CARE
IA41756OtherWELLMARK
IA32236OtherMEDICAL LICENSE
IA12250Medicare PIN
IA41756OtherWELLMARK