Provider Demographics
NPI:1598325151
Name:CORNERSTONE PEDIATRICS AND FAMILY ALLERGY, PLC
Entity Type:Organization
Organization Name:CORNERSTONE PEDIATRICS AND FAMILY ALLERGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-546-6866
Mailing Address - Street 1:6800 LAKE DRIVE
Mailing Address - Street 2:#260
Mailing Address - City:WEST DES MONIES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-822-3192
Mailing Address - Fax:
Practice Address - Street 1:6800 LAKE DRIVE
Practice Address - Street 2:#260
Practice Address - City:WEST DES MONIES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-822-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty