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General NPI Number Information
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NPI Number | 1548310394
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Entity Type | Organization
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Legal Business Name | JOHN M. IPPOLITO MD, P.C
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 201 RIDGE ST SUITE 301
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-256-0791
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Fax | 712-256-0807
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Provider Business Mailing Address
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Address Line | 201 RIDGE ST SUITE 301
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-256-0791
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Fax | 712-256-0807
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN M IPPOLITO
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Credential | M.D.
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Telephone | 712-256-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25954
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License Number State | IA
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