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General NPI Number Information
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NPI Number | 1710930086
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Entity Type | Organization
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Legal Business Name | DUBUQUE INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 107 S 11TH ST STE 2
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City | MANCHESTER
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State | IA
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Zip | 52057-2220
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Country | US
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Telephone | 563-927-2532
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Fax | 563-927-5579
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Provider Business Mailing Address
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Address Line | 1515 DELHI ST STE 100
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City | DUBUQUE
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State | IA
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Zip | 52001-6320
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Country | US
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Telephone | 563-557-9111
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Fax | 563-589-4046
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MARIAH ANN BRANDENBURG
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Credential |
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Telephone | 563-589-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | IA
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