Basic Information
| Provider Information | |||||||||
| NPI: | 1619193943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAXENA | ||||||||
| FirstName: | WILL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2941 SIERRA CT SW | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522408503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193377642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1314 S STUART ST | ||||||||
| Address2: | |||||||||
| City: | SIGOURNEY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525911154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416223840 | ||||||||
| FaxNumber: | 6416223529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 05/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38057 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | L-2646 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1619193943 | 05 | IA | MEDICAID | P00694368 | 01 | IA | RR MEDICARE | OTHER |