Organization
WEST BROADWAY CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISAM ELIAS MARAR M.D. (PRESIDENT)
(712) 256-5600
Entity
Organization
Contact information
Practice address
16 S 17TH ST, COUNCIL BLUFFS, IA 51501-3818
(712) 256-5600
Mailing address
16 S 17TH ST, COUNCIL BLUFFS, IA 51501-3818
(712) 256-5600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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