Provider Demographics
NPI:1588771752
Name:SCHUTTE-SCHENCK, SARA L (DO)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:SCHUTTE-SCHENCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SCHENCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9000
Mailing Address - Fax:515-643-7509
Practice Address - Street 1:800 E 1ST ST STE 2200
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021
Practice Address - Country:US
Practice Address - Phone:515-643-9000
Practice Address - Fax:515-643-7509
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-02717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3097014Medicaid
IAF59202Medicare UPIN
IA3097014Medicaid