Healthcare Provider Details

I. General information

NPI: 1942596572
Provider Name (Legal Business Name): CHRISTOPHER-ALEX SCUKA KABRIEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PLEASANT ST STE 300
DES MOINES IA
50309-1412
US

IV. Provider business mailing address

1200 PLEASANT ST.
DES MOINES IA
50309
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-8923
  • Fax: 515-241-8728
Mailing address:
  • Phone: 515-241-5926
  • Fax: 515-241-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04564
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: