Provider Demographics
NPI:1508127705
Name:QUAM, CARLY M (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:M
Last Name:QUAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:M
Other - Last Name:UTESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1241 S GRANT ROAD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401
Mailing Address - Country:US
Mailing Address - Phone:712-792-1500
Mailing Address - Fax:712-792-7597
Practice Address - Street 1:1241 S GRANT ROAD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401
Practice Address - Country:US
Practice Address - Phone:712-792-1500
Practice Address - Fax:712-792-7597
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine