Eastern Iowa Dermatology PLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35482 Issued in IA

Legal business name

EASTERN IOWA DERMATOLOGY PLC

Practice address

2880 Aaa Court
Bettendorf, IA 52722-3206

Phone

(563) 359-7546

Fax

(563) 359-8037

NPI assigned

Jun 19, 2007

Last updated

Mar 30, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Manish G Kumar, MDNPI 1033198395

Title

President/Physician Owner

Phone

(563) 359-7546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Manish G Kumar, M.D.

  • Dermatology Physician
  • Bettendorf, IA
  • NPI 1033198395
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1942405808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 AAA COURT",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223206",
            "telephone_number": "563-359-7546",
            "fax_number": "563-359-8037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 AAA COURT",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223206",
            "telephone_number": "563-359-7546",
            "fax_number": "563-359-8037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN IOWA DERMATOLOGY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "KUMAR",
        "authorized_official_first_name": "MANISH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN OWNER",
        "authorized_official_telephone_number": "563-359-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "35482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Dugan
• Jennifer L Duncan, LISW
• Ryan Patrick Dunlay, M.D.
• Michael Roy Dunn, D.C.
• James Kent Earel Jr., PA-C
• Ashley L Ebert, ARNP
• Tina J Eckhardt, M.D.
• Megan Ryan Edens
• Shannon Dawn Edmond, ARNP
• Eduardo L Ricaurte MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.