Provider Demographics
NPI:1952388381
Name:KERKHOFF, TERI J (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:J
Last Name:KERKHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:JANE
Other - Last Name:KUSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4189 WESTLAWN
Mailing Address - Street 2:UNIVERSITY OF IOWA STUDENT HEALTH SERVICE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1100
Mailing Address - Country:US
Mailing Address - Phone:319-335-8370
Mailing Address - Fax:319-335-7247
Practice Address - Street 1:4189 WESTLAWN
Practice Address - Street 2:UNIVERSITY OF IOWA STUDENT HEALTH SERVICE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1100
Practice Address - Country:US
Practice Address - Phone:319-335-8370
Practice Address - Fax:319-335-7247
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2440412Medicaid
IA39659OtherWELLMARK BCBS
IA2440412Medicaid
IAI16046Medicare PIN