Healthcare Provider Details

I. General information

NPI: 1700291291
Provider Name (Legal Business Name): MICHAEL JAMES VALLIERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PLEASANT ST STE 211
DES MOINES IA
50309-1411
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9770
  • Fax: 515-875-9771
Mailing address:
  • Phone: 515-875-9925
  • Fax: 515-875-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-45885
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: