Provider Demographics
NPI:1407864002
Name:MAY, EILEEN (DO)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 6TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2607
Mailing Address - Country:US
Mailing Address - Phone:515-643-8672
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:112 E DETROIT AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1860
Practice Address - Country:US
Practice Address - Phone:515-961-5324
Practice Address - Fax:515-961-0116
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1172759Medicaid
IA2172759Medicaid
IA21180Medicare ID - Type Unspecified
IND46449Medicare UPIN