Provider Demographics
NPI:1982942702
Name:IOWA DERMATOLOGY CLINIC PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC PLC
Other - Org Name:RADIANT COMPLEXIONS DERMATOLOGY CLINICS OR RADIANT PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:5152-263-1116
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-226-3116
Mailing Address - Fax:515-391-9262
Practice Address - Street 1:26 S 1ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5032
Practice Address - Country:US
Practice Address - Phone:641-753-2150
Practice Address - Fax:641-753-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty