Provider Demographics
NPI:1235111261
Name:KUESTNER, LAURIE M (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:KUESTNER
Suffix:
Gender:F
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 9170
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-9170
Mailing Address - Country:US
Mailing Address - Phone:515-633-3600
Mailing Address - Fax:515-633-3838
Practice Address - Street 1:5880 UNIVERSITY AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8209
Practice Address - Country:US
Practice Address - Phone:515-633-3660
Practice Address - Fax:515-362-4114
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA308612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0129486Medicaid
IA0129486Medicaid
IAF34970Medicare UPIN