Healthcare Provider Details

I. General information

NPI: 1336065739
Provider Name (Legal Business Name): GRACE HEITHOLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE BRODERSEN MD

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1415 WOODLAND AVE STE 140
DES MOINES IA
50309-3203
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR-14033
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: