Provider Demographics
NPI:1225004799
Name:AMELN, RICHARD T (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:AMELN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6414
Mailing Address - Country:US
Mailing Address - Phone:641-683-3195
Mailing Address - Fax:641-683-3197
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6414
Practice Address - Country:US
Practice Address - Phone:641-683-3195
Practice Address - Fax:641-683-3197
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA22300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0420471Medicaid
AO1775Medicare UPIN
AO1775Medicare UPIN