Organization
CORNERSTONE PEDIATRICS AND FAMILY ALLERGY, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA J FEDERLY (OWNER/PHYSICIAN)
(952) 546-6866
Entity
Organization
Contact information
Practice address
6800 LAKE DRIVE, #260, WEST DES MONIES, IA 50266
(515) 822-3192
Mailing address
6800 LAKE DRIVE, #260, WEST DES MONIES, IA 50266
(515) 822-3192
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
06/17/2019
Last updated
07/30/2020
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