Healthcare Provider Details

I. General information

NPI: 1841434537
Provider Name (Legal Business Name): OLEG A SHCHELOCHKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1007
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1007
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-4016
  • Fax: 319-356-3347
Mailing address:
  • Phone: 319-356-4016
  • Fax: 319-356-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number38637
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38637
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN2800
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: