MEDICARE: HAWKEYE ANESTHESIA PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1508195561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWKEYE ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	1916 OAK KNOLLS CT SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3963
Country	:	US
Telephone Number	:	319-364-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 A AVENUE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52406-3026
Country	:	US
Telephone Number	:	319-369-7211
Fax Number	:	319-364-3057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARY C KEMEN
Credential	:	M.D.
Telephone Number	:	319-213-2002

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	11/21/2014

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