Kent P Ellerbroek, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

20213 Issued in IA

Practice address

541 King Dr
Waterloo, IA 50702-5959

Phone

(319) 235-6323

Fax

(319) 235-0249

NPI assigned

Dec 2, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert W. Fuelling, DC, PC

  • Chiropractor
  • Waterloo, IA
  • NPI 1598941163
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223942400000",
    "number": "1104800192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 KING DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025959",
            "telephone_number": "319-235-6323",
            "fax_number": "319-235-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 KING DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025959",
            "telephone_number": "319-235-6323",
            "fax_number": "319-235-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERBROEK",
        "first_name": "KENT",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2008-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "20213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0169805",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elitecare Medical Transport LLC
• Elitecare Medical Transportation
• Gabriel Khalil Eljdid, DO
• Alena Davida Ellerbroek, MSN,FNP
• Justin Craig Ellerbroek, M.D.
• Kimberly Ellingson, LMHC
• Shanna Ruth Elliott, DO
• Tracy R Elliott, ARNP, MSN
• Elmstead Counseling LLC
• Justin J Elwood, MD

• Dermatology Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Dermatology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.