Provider Demographics
NPI:1396824165
Name:SITUMEANG, DJONGGI W (MD)
Entity Type:Individual
Prefix:DR
First Name:DJONGGI
Middle Name:W
Last Name:SITUMEANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:501 S WHITE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2600
Mailing Address - Country:US
Mailing Address - Phone:319-385-6700
Mailing Address - Fax:319-385-6703
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-6700
Practice Address - Fax:319-385-6703
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA29357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3086926Medicaid
IA3086926Medicaid
IAF35869Medicare UPIN