Healthcare Provider Details

I. General information

NPI: 1700469608
Provider Name (Legal Business Name): KEVIN DOU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

IV. Provider business mailing address

1549 FOSTER RD
IOWA CITY IA
52245-1647
US

V. Phone/Fax

Practice location:
  • Phone: 319-296-8753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-57527
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: