Provider Demographics
NPI:1386886257
Name:DIRKSEN, RACHAEL RICKERTSEN (MD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:RICKERTSEN
Last Name:DIRKSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:RAELYNN
Other - Last Name:RICKERTSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 E 9TH ST
Mailing Address - Street 2:UIHC IRL, INTERNAL MEDICINE
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2209
Mailing Address - Country:US
Mailing Address - Phone:319-467-2000
Mailing Address - Fax:319-467-2512
Practice Address - Street 1:105 E 9TH ST
Practice Address - Street 2:UIHC IRL, INTERNAL MEDICINE
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2209
Practice Address - Country:US
Practice Address - Phone:319-467-2000
Practice Address - Fax:319-467-2512
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA40261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program