Healthcare Provider Details

I. General information

NPI: 1790772051
Provider Name (Legal Business Name): LAURIS C KALDJIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 9TH ST
CORALVILLE IA
52241
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2410
Mailing address:
  • Phone: 319-335-6706
  • Fax: 319-356-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number33692
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33692
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: