Provider Demographics
NPI:1437116100
Name:WESTERCAMP, JILL SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:WESTERCAMP
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 1:6000 FOXBORO RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-8770
Mailing Address - Country:US
Mailing Address - Phone:515-334-0092
Mailing Address - Fax:
Practice Address - Street 1:12368 STRATFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8162
Practice Address - Country:US
Practice Address - Phone:515-226-9810
Practice Address - Fax:515-226-8408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA323432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5189902Medicaid
IA5189902Medicaid
G70642Medicare UPIN