Organization
STATE UNIVERSITY OF IOWA
Active
Other names
UI Family Care Perry
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH L FISHER (CFO)
(319) 384-2844
Entity
Organization
Contact information
Practice address
616 10TH ST, PERRY, IA 50220-2221
(515) 465-3553
Mailing address
2941 SIERRA CT SW, IOWA CITY, IA 52240-8503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280040
—
IA
01
—
33267
WELLMARK
IA
01
—
CK8851
RR MEDICARE
IA
Enumeration date
05/05/2006
Last updated
07/07/2009
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