1619001781 NPI number — HEIDI GAYLE DAHLEM M.D.

Table of content: STEPHANEE MARIE SWANSON (NPI 1316627698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619001781 NPI number — HEIDI GAYLE DAHLEM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHLEM
Provider First Name:
HEIDI
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONN
Provider Other First Name:
HEIDI
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619001781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
543 7TH ST SE
Provider Second Line Business Mailing Address:
INTERNIST ASSOCIATES OF IOWA
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52401-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-861-7600
Provider Business Mailing Address Fax Number:
319-861-7601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 7TH ST SE
Provider Second Line Business Practice Location Address:
INTERNIST ASSOCIATES OF IOWA
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52401-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-861-7600
Provider Business Practice Location Address Fax Number:
319-861-7601
Provider Enumeration Date:
03/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R-7258 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 37314 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 70641 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".