MEDICARE: DR. DONALD RICHARD WIRTANEN D.O.

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	207Q00000X	Family Medicine Physician	82100	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1184623985	OTHER	IA	MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184623985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD RICHARD WIRTANEN D.O.

Provider Business Mailing Address
First Line	:	202 N MADISON ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1425
Country	:	US
Telephone Number	:	641-664-1400
Fax Number	:	641-664-1410

Provider Business Practice Location Address
First Line	:	202 N MADISON ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1425
Country	:	US
Telephone Number	:	641-664-1400
Fax Number	:	641-664-1410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	06/04/2010

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