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Organization
IOWA PLASTIC SURGERY CENTER LC
Active
Organization
IOWA PLASTIC SURGERY CENTER LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN ADAM VANRAALTE M.D. (OWNER)
(563) 322-8877
Entity
Organization
Contact information
Practice address
4334 E 53RD ST, DAVENPORT, IA 52807-3039
(563) 322-8877
(563) 322-8375
Mailing address
4334 E 53RD ST, DAVENPORT, IA 52807-3039
(563) 322-8877
(563) 322-8375
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
29526
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IA0113241
—
IA
Enumeration date
01/10/2006
Last updated
02/15/2010
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