Provider Demographics
NPI:1114971546
Name:PINNICK, SALLY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MARIE
Last Name:PINNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 73RD ST
Mailing Address - Street 2:#8
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1321
Mailing Address - Country:US
Mailing Address - Phone:515-224-2055
Mailing Address - Fax:515-224-2387
Practice Address - Street 1:1000 73RD ST
Practice Address - Street 2:#8
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1321
Practice Address - Country:US
Practice Address - Phone:515-224-2055
Practice Address - Fax:515-224-2387
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA23537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1082750Medicaid
IA1082750Medicaid
IAA02313Medicare UPIN