Provider Demographics
NPI:1619001781
Name:DAHLEM, HEIDI GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:GAYLE
Last Name:DAHLEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:GAYLE
Other - Last Name:CONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543 7TH ST SE
Mailing Address - Street 2:INTERNIST ASSOCIATES OF IOWA
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1929
Mailing Address - Country:US
Mailing Address - Phone:319-861-7600
Mailing Address - Fax:319-861-7601
Practice Address - Street 1:543 7TH ST SE
Practice Address - Street 2:INTERNIST ASSOCIATES OF IOWA
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1929
Practice Address - Country:US
Practice Address - Phone:319-861-7600
Practice Address - Fax:319-861-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7258207R00000X
IA37314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70641OtherWELLMARK BCBS
IA70641OtherWELLMARK BCBS