Healthcare Provider Details

I. General information

NPI: 1063770576
Provider Name (Legal Business Name): DR. CAITLIN SIOBHAN PEDATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E 12TH ST FL 5
DES MOINES IA
50319-1002
US

IV. Provider business mailing address

111 MICHIGAN AVE NW W3.5, 600
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 515-281-3826
  • Fax:
Mailing address:
  • Phone: 202-476-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD-45336
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: