Healthcare Provider Details

I. General information

NPI: 1346200722
Provider Name (Legal Business Name): MARK POSPISIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1251
US

IV. Provider business mailing address

PO BOX 5610
CEDAR RAPIDS IA
52406-5610
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6297
  • Fax: 319-398-6249
Mailing address:
  • Phone: 319-369-4505
  • Fax: 319-369-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23018
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2011049
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: