Individual
LISA KLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2508 E UNIVERSITY AVE, BROADLAWNS EAST UNIVERSITY CLINIC, DES MOINES, IA 50317-5313
(515) 282-3278
(515) 282-5354
Mailing address
2508 E UNIVERSITY AVE, DES MOINES, IA 50317-5313
(515) 282-3278
(515) 282-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02866
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0139667
—
IA
Enumeration date
08/11/2006
Last updated
01/26/2017
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