Provider Demographics
NPI:1639541410
Name:IOWA DERMATOLOGY CLINIC, PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC, PLC
Other - Org Name:RADIANT COMPLEXIONS DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-226-3116
Mailing Address - Street 1:1510 SW ORALABOR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7147
Mailing Address - Country:US
Mailing Address - Phone:515-964-3467
Mailing Address - Fax:515-964-3672
Practice Address - Street 1:1510 SW ORALABOR RD STE C
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7147
Practice Address - Country:US
Practice Address - Phone:515-964-3467
Practice Address - Fax:515-964-3672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-20
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty