Individual
MICHAEL L DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1443 PROSPECT BLVD, WATERLOO, IA 50701-4953
(319) 234-6553
(319) 272-2038
Mailing address
PO BOX 2880, WATERLOO, IA 50704-2880
(319) 272-2152
(319) 272-2038
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19538
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128801
—
IA
01
—
110115799
RR MEDICARE
IA
Enumeration date
12/29/2005
Last updated
09/26/2008
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