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Individual

DR. THOMAS A. MALLISEE III

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1111 6TH AVE, DES MOINES, IA 50314-2613
(515) 643-2667
(515) 643-2978
Mailing address
1111 6TH AVE, DES MOINES, IA 50314-2613
(515) 643-2667
(515) 643-2978

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
32854
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0192344
IA
Enumeration date
10/10/2005
Last updated
07/08/2007
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