Individual
COLIN KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1622
(515) 271-1411
Mailing address
PO BOX 1936, DES MOINES, IA 50306-1936
(515) 471-9243
(515) 471-9319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03210
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0219006
—
IA
01
—
080161522
RR MEDICARE
IA
Enumeration date
08/18/2005
Last updated
02/24/2010
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