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General NPI Number Information
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NPI Number | 1184787343
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Entity Type | Organization
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Legal Business Name | HEARTLAND VASCULAR MEDICINE AND SURGERY PC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 974 73RD ST SUITE 23
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50324-1024
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Country | US
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Telephone | 515-284-1976
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Fax | 515-223-3010
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Provider Business Mailing Address
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Address Line | 974 73RD ST SUITE 23
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50324-1024
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Country | US
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Telephone | 515-284-1976
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Fax | 515-223-3010
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN RUSSELL KOSLOW
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Credential | M.D, F.A.C.S
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Telephone | 515-284-1976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 30390
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License Number State | IA
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