Provider Demographics
NPI:1023096435
Name:LONZARICH, DENNIS S (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:LONZARICH
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 1:1271 8TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2650
Mailing Address - Country:US
Mailing Address - Phone:515-224-4993
Mailing Address - Fax:515-224-1505
Practice Address - Street 1:1271 8TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2650
Practice Address - Country:US
Practice Address - Phone:515-224-4993
Practice Address - Fax:515-224-1505
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33072208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190553Medicaid
IA1023096435Medicaid
IA0190553Medicaid
IA71926085Medicare PIN
IAI0442Medicare PIN