Organization
KENT P ELLERBROEK MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT P ELLERBROEK M.D. (MEDICAL DOCTOR)
(319) 235-6323
Entity
Organization
Contact information
Practice address
541 KING DR, WATERLOO, IA 50702-5959
(319) 235-6323
(319) 235-0249
Mailing address
541 KING DR, WATERLOO, IA 50702-5959
(319) 235-6323
(319) 235-0249
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
202213
IA
Other
Enumeration date
07/07/2008
Last updated
10/14/2008
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