=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700689908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN SEVERIN SVENDSEN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2025
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HAWKINS DR
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52242-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-356-1616
-----------------------------------------------------
Fax | 319-356-2587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8451 GLEN SCOTT DR S
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46236-9272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-966-2035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | R-13441
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------