Provider Demographics
NPI:1851316681
Name:DAVENPORT SURGICAL GROUP PC
Entity Type:Organization
Organization Name:DAVENPORT SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOHMULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-421-3050
Mailing Address - Street 1:1228 E RUSHOLME ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-421-3040
Mailing Address - Fax:563-421-3049
Practice Address - Street 1:1228 E RUSHOLME ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804
Practice Address - Country:US
Practice Address - Phone:563-421-3050
Practice Address - Fax:563-421-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
71999Medicare ID - Type Unspecified