Provider Demographics
NPI:1437198991
Name:FELDKAMP, MARK A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:FELDKAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:1094 220TH ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:IA
Practice Address - Zip Code:50648-9400
Practice Address - Country:US
Practice Address - Phone:319-827-3000
Practice Address - Fax:319-827-2393
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4178616Medicaid
IA4178616Medicaid
IAI15798Medicare PIN