Provider Demographics
NPI:1952565368
Name:ACHERKAN, DMITRIY M (MD)
Entity Type:Individual
Prefix:
First Name:DMITRIY
Middle Name:M
Last Name:ACHERKAN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-668-2722
Mailing Address - Fax:319-688-2491
Practice Address - Street 1:819 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-9333
Practice Address - Country:US
Practice Address - Phone:319-668-2722
Practice Address - Fax:319-688-2491
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-39445207Q00000X, 207P00000X
IA39445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39445OtherSTATE MEDICAL LICENSE
IA1952565368Medicaid
IA1952565368Medicaid