Healthcare Provider Details

I. General information

NPI: 1245807718
Provider Name (Legal Business Name): SETH MOMMSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST # B5
DES MOINES IA
50309-1453
US

IV. Provider business mailing address

1200 PLEASANT ST # B5
DES MOINES IA
50309-1453
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-4497
  • Fax:
Mailing address:
  • Phone: 515-241-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-12108
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: