Provider Demographics
NPI:1538301254
Name:IOWA LAKES ORTHOPAEDICS, PC
Entity Type:Organization
Organization Name:IOWA LAKES ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-336-5311
Mailing Address - Street 1:2309 23RD ST.
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-2342
Mailing Address - Country:US
Mailing Address - Phone:712-336-5311
Mailing Address - Fax:712-336-0020
Practice Address - Street 1:515 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2342
Practice Address - Country:US
Practice Address - Phone:712-336-5311
Practice Address - Fax:712-336-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26094207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0288350002Medicare NSC