Healthcare Provider Details

I. General information

NPI: 1316923311
Provider Name (Legal Business Name): DANIEL H GERVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 515-224-1777
  • Fax: 515-222-0226
Mailing address:
  • Phone: 515-224-1777
  • Fax: 515-222-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20448
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number20448
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number20448
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: