Provider Demographics
NPI:1578527974
Name:STANKOVICH, MARINA V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:V
Last Name:STANKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-247-4240
Mailing Address - Fax:515-247-4239
Practice Address - Street 1:1111 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-247-4240
Practice Address - Fax:515-247-4239
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36359208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI46692Medicare UPIN
IAP00473267OtherRAILROAD MC
IAI20150Medicare PIN
IA1578527974Medicaid
IA70333OtherBLUE CROSS BLUE SHIELD