Provider Demographics
NPI:1962683243
Name:AERTS, JOHAN (DO)
Entity Type:Individual
Prefix:
First Name:JOHAN
Middle Name:
Last Name:AERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-8770
Mailing Address - Fax:515-643-8772
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 2310
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-643-8770
Practice Address - Fax:515-643-8772
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04079208600000X
MI5315029870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI67100002Medicare PIN
IA1962683243OtherWELLMARK BC/BS OF IA
IA1962683243Medicaid