Provider Demographics
NPI:1780767582
Name:SVENSSON, CHARLES HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:SVENSSON
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 1:1250 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2316
Mailing Address - Country:US
Mailing Address - Phone:515-263-2600
Mailing Address - Fax:515-263-2620
Practice Address - Street 1:1250 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2316
Practice Address - Country:US
Practice Address - Phone:515-263-2600
Practice Address - Fax:515-263-2620
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-39150207V00000X
AL15478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934279Medicaid
IA1780767582Medicaid
IA719260364Medicare PIN
AL009934279Medicaid
AL009934279Medicaid