Healthcare Provider Details

I. General information

NPI: 1609829688
Provider Name (Legal Business Name): ROBERT JOHN CAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 W RIDGEWAY AVE STE 107
WATERLOO IA
50701-4588
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5907
  • Fax: 319-833-5908
Mailing address:
  • Phone: 319-833-5907
  • Fax: 319-833-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21323
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: