Provider Demographics
NPI:1861480667
Name:DAHMOUSH, LAILA (MD)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:DAHMOUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4440
Mailing Address - Fax:319-384-8052
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4440
Practice Address - Fax:319-384-8052
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34002207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0240895Medicaid
IA1240895Medicaid
IA33929OtherWELLMARK BCBS
IA40381OtherWELLMARK BCBS
IA40381OtherWELLMARK BCBS
IA33929OtherWELLMARK BCBS
IAP00050270Medicare PIN
IAI2121Medicare PIN