Individual
MARK A TANNENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5880 UNIVERSITY AVE STE. 102, WEST DES MOINES, IA 50266-8220
(515) 633-3600
(515) 288-0840
Mailing address
PO BOX 9170, DES MOINES, IA 50306-9170
(515) 633-3600
(515) 633-3838
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
27144
IA
207RI0011X
Interventional Cardiology Physician
Primary
27144
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057034
—
IA
Enumeration date
11/17/2005
Last updated
06/14/2020
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