Organization
DUBUQUE PAIN CLINIC
Active
Organization
DUBUQUE PAIN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN FOMITCHEV MD (PRESIDENT)
(563) 564-1283
Entity
Organization
Contact information
Practice address
250 MERCY DR, DUBUQUE, IA 52001-7320
(563) 589-8665
Mailing address
2260 SAMANTHA DR, DUBUQUE, IA 52002-0485
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
34875
IA
208VP0014X
Interventional Pain Medicine Physician
Primary
34875
IA
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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