Healthcare Provider Details

I. General information

NPI: 1033402375
Provider Name (Legal Business Name): TRISHIA A FILIPIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S STORY ST
BOONE IA
50036-4739
US

IV. Provider business mailing address

120 S STORY ST
BOONE IA
50036-4739
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-4444
  • Fax:
Mailing address:
  • Phone: 515-432-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-41903
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59929
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: