Organization
STATE UNIVERSITY OF IOWA
Active
Parent organization
STATE UNIVERSITY OF IOWA
Other names
University of Iowa Health Care, University of Iowa Hospitals & Clinics/Medical Service Plan
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE UNIVERSITY OF IOWA
Authorized official
DOUGLAS J VANDAELE MD (ASSOCIATE DEAN)
(319) 353-8162
Entity
Organization
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242
(319) 356-1616
(319) 384-5164
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-1616
(319) 384-5164
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IA
207R00000X
Internal Medicine Physician
—
IA
208000000X
Pediatrics Physician
—
IA
208600000X
Surgery Physician
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004246
—
IA
01
—
33537
WELLMARK BCBS OF IA
IA
Enumeration date
08/09/2005
Last updated
04/30/2024
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