Provider Demographics
NPI:1821074071
Name:DEWILD, LOUIS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOHN
Last Name:DEWILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 WESTOWN PKWY STE 236
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6720
Mailing Address - Country:US
Mailing Address - Phone:515-401-1950
Mailing Address - Fax:515-401-1955
Practice Address - Street 1:4201 WESTOWN PKWY STE 236
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6720
Practice Address - Country:US
Practice Address - Phone:515-401-1950
Practice Address - Fax:515-401-1955
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35477207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA244177OtherMIDLANDS PROVIDER #
IA35477OtherTRICARE PROVIDER #
IA36410OtherBLUE SHIELD PROVIDER #
IA0440651Medicaid
IAIA0100OtherJOHN DEERE PROVIDER #
IAP00141089OtherRAILROAD MEDICARE #
IA0440651Medicaid
IAI12054Medicare ID - Type UnspecifiedMEDICARE PROVIDER #