Provider Demographics
NPI:1487648325
Name:CLEVENGER-HOEFT, MIA D (MD)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:D
Last Name:CLEVENGER-HOEFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2769 HEARTLAND DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2732
Mailing Address - Country:US
Mailing Address - Phone:319-337-3193
Mailing Address - Fax:319-545-4570
Practice Address - Street 1:2769 HEARTLAND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-337-3193
Practice Address - Fax:319-545-4570
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA32926207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA160043052OtherRAILROAD
IA48613OtherBC/BS
IA0186288Medicaid
IA0186288Medicaid
IAG92453Medicare UPIN
IA48613OtherBC/BS