Provider Demographics
NPI:1205824000
Name:MARCUSSEN, BRITT (MD)
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:
Last Name:MARCUSSEN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-7000
Mailing Address - Fax:319-384-7822
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-7000
Practice Address - Fax:319-384-7822
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1205824000Medicaid
IA23933OtherWELLMARK BCBS
IA72196OtherWELLMARK UIQC OCTC
IA080164213OtherRR MEDICARE
IA1152983Medicaid
IA080164213OtherRR MEDICARE
IA1152983Medicaid
IA1205824000Medicaid