Provider Demographics
NPI:1790754695
Name:VANDER MEIDE, JOEL PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:PHILIP
Last Name:VANDER MEIDE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5900 NW 86TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2284
Mailing Address - Country:US
Mailing Address - Phone:515-276-6133
Mailing Address - Fax:515-334-7356
Practice Address - Street 1:5900 NW 86TH ST
Practice Address - Street 2:STE 100
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2284
Practice Address - Country:US
Practice Address - Phone:515-276-6133
Practice Address - Fax:515-334-7356
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA3420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1790754695Medicaid
IAP00810887OtherRR MEDICARE
IAP00810887OtherRR MEDICARE