Provider Demographics
NPI:1407923758
Name:HARBACH, TODD J (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
Last Name:HARBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAUREL ST STE A
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3045
Mailing Address - Country:US
Mailing Address - Phone:515-247-8400
Mailing Address - Fax:515-248-8888
Practice Address - Street 1:450 LAUREL ST STE A
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-247-8400
Practice Address - Fax:515-248-8888
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146094207X00000X
IAMD-42246207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
431560263OtherTRICARE
MO204974505Medicaid
200037962OtherRAILROAD MEDICARE
431560263OtherTRICARE
MO204974505Medicaid
MO113013230Medicare PIN