MEDICARE: SAMUEL M MAURICE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036.119290	IL
2	208600000X	Surgery Physician	39356	IA
3	2086S0122X	Plastic and Reconstructive Surgery Physician	036.119290	IL
4	2086S0122X	Plastic and Reconstructive Surgery Physician	39356	IA
5	2086S0122X	Plastic and Reconstructive Surgery Physician	MD-39356	IA

General Provider Information

NPI Number	:	1033328109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL M MAURICE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-1475
Country	:	US
Telephone Number	:	515-643-5455
Fax Number	:	515-643-6459

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST STE 151
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-7046
Country	:	US
Telephone Number	:	515-643-5455
Fax Number	:	515-643-6459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/10/2024

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Directions to “ SAMUEL M MAURICE M.D.” Practice Location

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