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NPI Code Detail

MEDICARE: MICHAEL DAVID VANNATTA DO

MEDICARE: MICHAEL DAVID VANNATTA DO
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
1207Q00000XFamily Medicine Physician02160IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
145044OTHERIAWELLMARK BC&BS IA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
436316OTHERIAWELLMARK BC&BS IA

General Provider Information

NPI Number : 1124035357
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DAVID VANNATTA DO
Provider Business Mailing Address
First Line : 1202 W HOWARD ST
Second Line :
City : KNOXVILLE
State : IA
Zip : 50138-3103
Country : US
Telephone Number : 641-828-7211
Fax Number : 641-842-7030
Provider Business Practice Location Address
First Line : 1202 W HOWARD ST
Second Line :
City : KNOXVILLE
State : IA
Zip : 50138-3103
Country : US
Telephone Number : 641-828-7211
Fax Number : 641-842-7030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 01/07/2014

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Directions to “ MICHAEL DAVID VANNATTA DO” Practice Location

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