Provider Demographics
NPI:1558475962
Name:TUNELL, MARK W (PA C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:TUNELL
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8487
Mailing Address - Country:US
Mailing Address - Phone:515-226-8484
Mailing Address - Fax:515-226-8487
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8487
Practice Address - Country:US
Practice Address - Phone:515-226-8487
Practice Address - Fax:515-226-8487
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA633207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I5924Medicare ID - Type Unspecified