Provider Demographics
NPI:1053312603
Name:DIGESTIVE AND LIVER DISEASE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE AND LIVER DISEASE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KOREEN
Authorized Official - Middle Name:KAY LEMASTER
Authorized Official - Last Name:RAYL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:515-223-4823
Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:STE 342
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7007
Mailing Address - Country:US
Mailing Address - Phone:515-223-4823
Mailing Address - Fax:515-223-0482
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 342
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7007
Practice Address - Country:US
Practice Address - Phone:515-223-4823
Practice Address - Fax:515-223-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0243857Medicaid
IA29502Medicare ID - Type Unspecified