Provider Demographics
NPI:1881603405
Name:FILLMAN, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FILLMAN
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 1:603 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-4700
Mailing Address - Country:US
Mailing Address - Phone:641-755-4000
Mailing Address - Fax:641-332-3888
Practice Address - Street 1:603 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-4700
Practice Address - Country:US
Practice Address - Phone:641-755-4000
Practice Address - Fax:641-332-3888
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1087817Medicaid
IA51709Medicare PIN
IAF45105Medicare UPIN