Provider Demographics
NPI:1245269489
Name:MEGIVERN, KATHLEEN A (DO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:MEGIVERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5664
Mailing Address - Country:US
Mailing Address - Phone:319-272-7425
Mailing Address - Fax:319-272-8059
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 111
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5664
Practice Address - Country:US
Practice Address - Phone:319-272-7425
Practice Address - Fax:319-272-8059
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-02122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6023333Medicaid
IAA02900Medicare UPIN
IA6023333Medicaid