Thomas Edward Dittmer, MD
Individual provider Active NPI Medical Microbiology Physician · Keokuk, IA
NPI 1477576692 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477576692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Microbiology Physician 207ZM0300X
- License
- 35921 (IA)
- Practice address
- 1600 Morgan St
Keokuk, IA 52632-3456 - Phone
- (319) 526-8750
- Fax
- (319) 524-5317
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35921 | IA | MD | Medical Microbiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Microbiology Physician | 207ZM0300X | 35921 | IA | Yes |
Addresses
Primary practice location
1600 Morgan St
Keokuk, IA 52632-3456
Mailing address
1600 Morgan St
Keokuk, IA 52632-3456
Phone (319) 526-8750
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38633 | Other | IA | BLUE CROSS |
| 0457275 | Medicaid | IA |
Other providers in Keokuk, IA
- Dave'S Place LLC
- Craig R Davenport
- Amanda Day
- Alyssa Hope Devericks
- Kelsey Dickens
- Juliann Finnegan Dorothy
- Jennifer R Dougherty
- Dr. John Lee MD PC
- Eric E Edwards
- Patrick J. Ewing
All providers in Keokuk, IA · Medical Microbiology Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.