Provider Demographics
NPI:1699887133
Name:DIMEO, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DIMEO
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:PO BOX 4925
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-4925
Mailing Address - Country:US
Mailing Address - Phone:515-643-5454
Mailing Address - Fax:515-643-5460
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-643-5454
Practice Address - Fax:515-643-5460
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA358412080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0462416Medicaid
IA39340OtherWELLMARK
IAI16014Medicare ID - Type Unspecified
IA0462416Medicaid