MEDICARE: OBSTETRIC AND GYNECOLOGIC ASSOCIATES OF IOWA CITY PC

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	207V00000X	Obstetrics & Gynecology Physician

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
2	08997	OTHER	IA	BC/BS
3	A002306	OTHER	IA	CHAMPUS
4	CP8135	OTHER	IA	RAILROAD

General Provider Information

NPI Number	:	1700870649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBSTETRIC AND GYNECOLOGIC ASSOCIATES OF IOWA CITY PC

Provider Business Mailing Address
First Line	:	2769 HEARTLAND DR
Second Line	:	SUITE 201
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2732
Country	:	US
Telephone Number	:	319-337-3193
Fax Number	:	319-545-4570

Provider Business Practice Location Address
First Line	:	2769 HEARTLAND DR
Second Line	:	SUITE 201
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2732
Country	:	US
Telephone Number	:	319-337-3193
Fax Number	:	319-545-4570

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LORI S WENZEL
Credential	:	M.D.
Telephone Number	:	319-337-3193

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	12/08/2011

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