Provider Demographics
NPI:1265199277
Name:IOWA DERMATOLOGY CLINIC PLC
Entity type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-697-0176
Mailing Address - Street 1:1005 BLAIRS FERRY RD NE STE 30
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1219
Mailing Address - Country:US
Mailing Address - Phone:319-289-7779
Mailing Address - Fax:319-320-4644
Practice Address - Street 1:1005 BLAIRS FERRY RD NE STE 30
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1219
Practice Address - Country:US
Practice Address - Phone:319-289-7779
Practice Address - Fax:319-320-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty