Provider Demographics
NPI:1881699890
Name:DANNENFELDT, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:DANNENFELDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:855 ILLINI DR
Practice Address - Street 2:STE 300
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2904
Practice Address - Country:US
Practice Address - Phone:309-281-2090
Practice Address - Fax:309-281-2099
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036059049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020348OtherHEALTH ALLIANCE
20127OtherIOWA HEALTH SOLUTIONS
IA97788OtherWELLMARK BC/BS
IL0120OtherJOHN DEERE HEALTH PLAN
IL036059049Medicaid
4796890014OtherDMERC
IA97835OtherWELLMARK BC/BS
4796890014OtherDMERC
020348OtherHEALTH ALLIANCE