MEDICARE: IOWA DERMATOLOGY CLINIC PLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1265199277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA DERMATOLOGY CLINIC PLC

Provider Business Mailing Address
First Line	:	1005 BLAIRS FERRY RD NE STE 30
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-1219
Country	:	US
Telephone Number	:	319-289-7779
Fax Number	:	319-320-4644

Provider Business Practice Location Address
First Line	:	1005 BLAIRS FERRY RD NE STE 30
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-1219
Country	:	US
Telephone Number	:	319-289-7779
Fax Number	:	319-320-4644

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. MATTHEW DAVID SCHEMMEL
Credential	:
Telephone Number	:	515-697-0176

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	11/24/2021

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