Healthcare Provider Details

I. General information

NPI: 1164576245
Provider Name (Legal Business Name): PATRICK HARLAN TRACY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EUCLID AVE
DES MOINES IA
50313-4403
US

IV. Provider business mailing address

PO BOX 746870
ATLANTA GA
30374-6870
US

V. Phone/Fax

Practice location:
  • Phone: 515-666-8670
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-04407
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO-04407
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4407
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: