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NPI Code Detail

MEDICARE: UROLOGY CENTER OF IOWA PLLC

MEDICARE: UROLOGY CENTER OF IOWA 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
1332B00000XDurable Medical Equipment & Medical Supplies
2208800000XUrology Physician

General Provider Information

NPI Number : 1689210155
Entity Type Code : Organization
Provider Name (Legal Business Name) : UROLOGY CENTER OF IOWA PLLC
Provider Business Mailing Address
First Line : 12129 UNIVERSITY AVE
Second Line :
City : CLIVE
State : IA
Zip : 50325-8287
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12129 UNIVERSITY AVE
Second Line :
City : CLIVE
State : IA
Zip : 50325-8287
Country : US
Telephone Number : 515-400-3550
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER/PARTNER
Name : MARK KELLERMAN
Credential : MD
Telephone Number : 515-249-1610
Provider Enumeration Date : 11/20/2019
Last Update Date : 03/12/2026

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Directions to “UROLOGY CENTER OF IOWA PLLC ” Practice Location

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