Provider Demographics
NPI:1891862033
Name:HEARTLAND DERMATOLGY & SKIN CANCER CENTER PC
Entity Type:Organization
Organization Name:HEARTLAND DERMATOLGY & SKIN CANCER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVA
Authorized Official - Middle Name:RISA
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-224-7088
Mailing Address - Street 1:12327 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8148
Mailing Address - Country:US
Mailing Address - Phone:515-224-7088
Mailing Address - Fax:515-224-9228
Practice Address - Street 1:12327 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8148
Practice Address - Country:US
Practice Address - Phone:515-224-7088
Practice Address - Fax:515-224-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACN3179OtherMEDICARE RAILROAD