Provider Demographics
NPI:1508238395
Name:IOWA DERMATOLOGY CLINIC, PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC, PLC
Other - Org Name:RADIANT COMPLEXIONS DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:515-226-3116
Mailing Address - Street 1:5921 SE 14TH ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1746
Mailing Address - Country:US
Mailing Address - Phone:515-287-5757
Mailing Address - Fax:515-287-0063
Practice Address - Street 1:5921 SE 14TH ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1746
Practice Address - Country:US
Practice Address - Phone:515-287-5757
Practice Address - Fax:515-287-0063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty