Provider Demographics
NPI:1609829688
Name:CAK, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:CAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5907
Mailing Address - Fax:319-833-5908
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 107
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-833-5907
Practice Address - Fax:319-833-5908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA21323208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19685OtherWELLMARK INS PLAN
IA2151605Medicaid
IA42141730704OtherJOHN DEERE HEALTH INS PLA
IA2151605Medicaid
IA42141730704OtherJOHN DEERE HEALTH INS PLA