Provider Demographics
NPI:1720170566
Name:IOWA SKIN CLINIC
Entity Type:Organization
Organization Name:IOWA SKIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-672-0123
Mailing Address - Street 1:PO BOX 22112
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-9402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2829
Practice Address - Country:US
Practice Address - Phone:515-314-8661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0418400Medicaid
IA0418400Medicaid