MEDICARE: DIGESTIVE AND LIVER DISEASE CONSULTANTS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician		IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053312603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE AND LIVER DISEASE CONSULTANTS, P.C.

Provider Business Mailing Address
First Line	:	1601 NW 114TH ST
Second Line	:	STE 342
City	:	CLIVE
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-223-4823
Fax Number	:	515-223-0482

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST
Second Line	:	STE 342
City	:	CLIVE
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-223-4823
Fax Number	:	515-223-0482

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. KOREEN KAY LEMASTER RAYL
Credential	:	B.S.N., RN
Telephone Number	:	515-223-4823

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/22/2020

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Directions to “DIGESTIVE AND LIVER DISEASE CONSULTANTS, P.C. ” Practice Location

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