Healthcare Provider Details

I. General information

NPI: 1285873695
Provider Name (Legal Business Name): HAWKEYE THERAPEUTICS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13360 61ST AVE
BLUE GRASS IA
52726-9662
US

IV. Provider business mailing address

13360 61ST AVE
BLUE GRASS IA
52726-9662
US

V. Phone/Fax

Practice location:
  • Phone: 563-381-4116
  • Fax:
Mailing address:
  • Phone: 563-381-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE MICHAEL SLIWA
Title or Position: MANAGER
Credential: ED.D.
Phone: 563-381-4116