MEDICARE: MARY CHOL

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1396628400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHOL

Provider Business Mailing Address
First Line	:	9055 CONEFLOWER DR UNIT 114
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-7536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9055 CONEFLOWER DR UNIT 114
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-7536
Country	:	US
Telephone Number	:	515-240-8268
Fax Number	:

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

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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Directions to “ MARY CHOL ” Practice Location

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