Provider Demographics
NPI:1295788214
Name:DUBUQUE INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:DUBUQUE INTERNAL MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-4066
Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-557-9111
Mailing Address - Fax:
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:STE 2100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6358
Practice Address - Country:US
Practice Address - Phone:563-589-4033
Practice Address - Fax:563-589-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
162500Medicare PIN
162500Medicare Oscar/Certification