Healthcare Provider Details

I. General information

NPI: 1154385557
Provider Name (Legal Business Name): CHRISTIAN PETER LEDET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

IV. Provider business mailing address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

V. Phone/Fax

Practice location:
  • Phone: 515-267-1819
  • Fax: 515-401-1313
Mailing address:
  • Phone: 515-267-1819
  • Fax: 515-401-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number32573
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD-32573
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: