Provider Demographics
NPI:1255679163
Name:IOWA DERMATOLOGY CLINIC PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC PLC
Other - Org Name:RADIANT COMPLEXIONS DERMATOLOGY CLINICS OR RADIANT PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:515-226-3116
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-226-8484
Mailing Address - Fax:515-226-8487
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-226-8484
Practice Address - Fax:515-226-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory