MEDICARE: SOMA, LLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1962363960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA, LLC

Provider Business Mailing Address
First Line	:	12107 STRATFORD DR
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8146
Country	:	US
Telephone Number	:	515-395-7661
Fax Number	:	515-395-7663

Provider Business Practice Location Address
First Line	:	12107 STRATFORD DR
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8146
Country	:	US
Telephone Number	:	515-395-7661
Fax Number	:	515-395-7663

Authorized Official
Title or Position	:	OWNER/COSMETIC SURGEON
Name	:	HARRY M CONDOLEON
Credential	:	DO
Telephone Number	:	515-320-0916

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	05/27/2026

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Directions to “SOMA, LLC ” Practice Location

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