Healthcare Provider Details

I. General information

NPI: 1831035286
Provider Name (Legal Business Name): PRINCE BASOAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-612-9595
  • Fax: 515-346-6721
Mailing address:
  • Phone: 515-612-9595
  • Fax: 515-346-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-13765
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: