MEDICARE: IOWA DERMATOLOGY CLINIC PLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1679062848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA DERMATOLOGY CLINIC PLC

Provider Business Mailing Address
First Line	:	6800 LAKE DR STE 350
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-2500
Country	:	US
Telephone Number	:	515-226-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 N 27TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4331
Country	:	US
Telephone Number	:	515-955-4440
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MATTHEW DAVID SCHEMMEL
Credential	:
Telephone Number	:	515-226-3116

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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