MEDICARE: INFORMED CHOICE OF IOWA CORPORATION

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1871043570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFORMED CHOICE OF IOWA CORPORATION

Provider Business Mailing Address
First Line	:	821 S GILBERT ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1742
Country	:	US
Telephone Number	:	319-358-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 S GILBERT ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1742
Country	:	US
Telephone Number	:	319-337-0575
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RACHEL OWEN
Credential	:
Telephone Number	:	319-358-1006

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/06/2016

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