Provider Demographics
NPI:1629042288
Name:FIALKOV, MARTIN JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JEROME
Last Name:FIALKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:JEROME
Other - Last Name:FIALKOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1201 63RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1943
Mailing Address - Country:US
Mailing Address - Phone:515-225-6861
Mailing Address - Fax:515-225-6864
Practice Address - Street 1:1201 63RD ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-1943
Practice Address - Country:US
Practice Address - Phone:515-225-6861
Practice Address - Fax:515-225-6864
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA363142084P0800X
PAMD024394E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04327OtherWELLMARK
IA248245OtherMIDLANDS CHOICE
IAI6552Medicare ID - Type Unspecified
IA248245OtherMIDLANDS CHOICE