Provider Demographics
NPI:1679648588
Name:PEIFFER, ANGELIKA JONGEDIJK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIKA
Middle Name:JONGEDIJK
Last Name:PEIFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W DONAHUE ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1077
Mailing Address - Country:US
Mailing Address - Phone:563-285-7284
Mailing Address - Fax:563-285-7284
Practice Address - Street 1:2700 27TH AVE
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-626-2391
Practice Address - Fax:319-626-2141
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA317322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0156315Medicaid
IA40476Medicare ID - Type Unspecified
IAG20467Medicare UPIN