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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