Healthcare Provider Details

I. General information

NPI: 1992362396
Provider Name (Legal Business Name): CHRISTIAN LOUIS MENEZES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

IV. Provider business mailing address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

V. Phone/Fax

Practice location:
  • Phone: 635-843-2265
  • Fax: 563-584-3227
Mailing address:
  • Phone: 635-843-2265
  • Fax: 563-584-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT019094
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO-06031
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: