Provider Demographics
NPI:1144213356
Name:RICHENBACHER, WAYNE E (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:E
Last Name:RICHENBACHER
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:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3541
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-688-7733
Practice Address - Fax:319-688-7734
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29203208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0099622Medicaid
IA11910OtherWELLMARK BCBS
IA11910OtherWELLMARK BCBS
IA020024263Medicare PIN
B36439Medicare UPIN