Provider Demographics
NPI:1629057104
Name:HELMINK, JEFFRE D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFRE
Middle Name:D
Last Name:HELMINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2927
Mailing Address - Country:US
Mailing Address - Phone:712-262-1890
Mailing Address - Fax:
Practice Address - Street 1:1823 HIGHWAY BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2226
Practice Address - Country:US
Practice Address - Phone:712-262-6320
Practice Address - Fax:712-264-3007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33107208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0207514Medicaid
IAH19003Medicare UPIN
IA20710Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER