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General NPI Number Information
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NPI Number | 1437472677
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Entity Type | Organization
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Legal Business Name | LOTUS TRAUMA CENTER, PLLC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 4211 GRAND AVE SUITE 4
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City | DES MOINES
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State | IA
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Zip | 50312-2423
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Country | US
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Telephone | 151-531-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 GRAND AVE SUITE 4
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City | DES MOINES
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State | IA
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Zip | 50312-2423
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Country | US
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Telephone | 151-531-4408
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MOLLIE SUSANN MICHELFELDER
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Credential | LISW
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Telephone | 15153144081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06761
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License Number State | IA
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