Provider Demographics
NPI:1760442529
Name:ZITTERGRUEN, JOHN HARLAN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARLAN
Last Name:ZITTERGRUEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8345
Mailing Address - Country:US
Mailing Address - Phone:515-224-9666
Mailing Address - Fax:515-224-5913
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8345
Practice Address - Country:US
Practice Address - Phone:515-224-9666
Practice Address - Fax:515-224-5913
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1760442529Medicaid
IA112326Medicaid
IA080063706Medicare PIN
IAE54970Medicare UPIN
IA112326Medicaid
IA17296Medicare PIN