Healthcare Provider Details

I. General information

NPI: 1487026266
Provider Name (Legal Business Name): IOWA DERMATOLOGY CLINIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UNIVERSITY AVE STE 350
WEST DES MOINES IA
50266-8219
US

IV. Provider business mailing address

6800 LAKE DR STE 285
WEST DES MOINES IA
50266-2544
US

V. Phone/Fax

Practice location:
  • Phone: 515-226-8484
  • Fax:
Mailing address:
  • Phone: 515-226-3116
  • Fax: 515-223-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES LOVE
Title or Position: OWNER
Credential: M.D.
Phone: 515-226-8484