Provider Demographics
NPI:1093194607
Name:LAIB, AMY CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:LAIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-0000
Mailing Address - Fax:319-272-1329
Practice Address - Street 1:2055 KIMBALL AVE STE 400
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-272-0000
Practice Address - Fax:319-272-1329
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-45353207Q00000X
IN11018072A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine