Healthcare Provider Details

I. General information

NPI: 1093836728
Provider Name (Legal Business Name): MEDERIC MICAH HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PRAIRIE MEADOW DR
IOWA CITY IA
52242-8001
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-8059
  • Fax: 319-384-9305
Mailing address:
  • Phone: 319-467-8059
  • Fax: 319-384-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number49735
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD-38299
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD-38299
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: