MEDICARE: BRENDA CRUIKSHANK 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	208000000X	Pediatrics Physician	19706	IA

General Provider Information

NPI Number	:	1164801668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA CRUIKSHANK M.D.

Provider Business Mailing Address
First Line	:	2105 GLENDALE RD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3221
Country	:	US
Telephone Number	:	319-351-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 GLENDALE RD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3221
Country	:	US
Telephone Number	:	319-351-5612
Fax Number	:

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

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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Directions to “ BRENDA CRUIKSHANK M.D.” Practice Location

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