Provider Demographics
NPI:1093726861
Name:KURT R. VANDER PLOEG, M.D., P.C.
Entity Type:Organization
Organization Name:KURT R. VANDER PLOEG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:VANDER PLOEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-628-2222
Mailing Address - Street 1:615 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1538
Mailing Address - Country:US
Mailing Address - Phone:641-628-2222
Mailing Address - Fax:641-628-2915
Practice Address - Street 1:615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1538
Practice Address - Country:US
Practice Address - Phone:641-628-2222
Practice Address - Fax:641-628-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17726OtherMIDLAND'S CHOICE PROVIDER
IA0317687Medicaid
IA13768OtherWELLMARK BCBS NUMBER
IA13768OtherWELLMARK BCBS NUMBER
IA17726OtherMIDLAND'S CHOICE PROVIDER
IA0317687Medicaid