Healthcare Provider Details

I. General information

NPI: 1366068942
Provider Name (Legal Business Name): MELISSA TOELLER-DESIMONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA TOELLER MD

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR DEPT OF
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 414-315-9388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR-11993
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: