Provider Demographics
NPI:1083650071
Name:DALIL, NASREDIN A (MD)
Entity Type:Individual
Prefix:
First Name:NASREDIN
Middle Name:A
Last Name:DALIL
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 1:4325 WILLIAMS BLVD SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-368-8400
Mailing Address - Fax:319-368-8405
Practice Address - Street 1:4325 WILLIAMS BLVD SW
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-368-8400
Practice Address - Fax:319-368-8405
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR7782207Q00000X
IAMD-38106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR7782OtherIOWA RESIDENT LICENSE