Healthcare Provider Details

I. General information

NPI: 1174659387
Provider Name (Legal Business Name): MIDWEST NEUROSCIENCE CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 PARK LN SUITE 400
WATERLOO IA
50702-5236
US

IV. Provider business mailing address

2500 GNAHN ST
BURLINGTON IA
52601-4416
US

V. Phone/Fax

Practice location:
  • Phone: 319-754-7271
  • Fax:
Mailing address:
  • Phone: 319-754-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SADHNA JANI
Title or Position: BUSINESS MANAGER
Credential: MBA
Phone: 319-754-7271