Healthcare Provider Details

I. General information

NPI: 1467411611
Provider Name (Legal Business Name): DUBUQUE FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N GRANDVIEW AVE SUITE D
DUBUQUE IA
52001-6328
US

IV. Provider business mailing address

320 N GRANDVIEW AVE SUITE D
DUBUQUE IA
52001-6328
US

V. Phone/Fax

Practice location:
  • Phone: 563-583-9300
  • Fax: 563-589-2555
Mailing address:
  • Phone: 563-583-9300
  • Fax: 563-589-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN KILGORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 563-583-9300