Healthcare Provider Details

I. General information

NPI: 1114905759
Provider Name (Legal Business Name): CHEST INFECTIOUS DISEASES AND CRITICAL CARE ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST STE 347
DES MOINES IA
50325-7046
US

IV. Provider business mailing address

1601 NW 114TH ST STE 347
DES MOINES IA
50325-7046
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-1777
  • Fax: 515-225-6750
Mailing address:
  • Phone: 515-224-1777
  • Fax: 515-225-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL C WITTE
Title or Position: PRESIDENT
Credential: MD
Phone: 515-224-1777