Healthcare Provider Details

I. General information

NPI: 1124522487
Provider Name (Legal Business Name): KHUSHDEEP SINGH VIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE STE 213
DES MOINES IA
50316-2365
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE STE 213
DES MOINES IA
50316-2365
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-1414
  • Fax: 515-224-5140
Mailing address:
  • Phone: 515-224-1414
  • Fax: 515-224-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number65319
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: