Provider Demographics
NPI:1679062848
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:MR
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 1:6800 LAKE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2500
Mailing Address - Country:US
Mailing Address - Phone:515-226-3116
Mailing Address - Fax:
Practice Address - Street 1:22 N 27TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4331
Practice Address - Country:US
Practice Address - Phone:515-955-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty