Provider Demographics
NPI:1790069243
Name:INFECTIOUS DISEASE PHYSICIANS OF IOWA CITY
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE PHYSICIANS OF IOWA CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-688-7440
Mailing Address - Street 1:540 E JEFFERSON ST STE 306
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2479
Mailing Address - Country:US
Mailing Address - Phone:319-688-7440
Mailing Address - Fax:319-887-2971
Practice Address - Street 1:540 E JEFFERSON ST STE 306
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2479
Practice Address - Country:US
Practice Address - Phone:319-688-7440
Practice Address - Fax:319-887-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29619261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF718191Medicare UPIN