Basic Information
| Provider Information | |||||||||
| NPI: | 1750904686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DVORAK | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 HICKMAN RD | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503141597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152828551 | ||||||||
| FaxNumber: | 5152822332 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 HICKMAN RD | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503141597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152828551 | ||||||||
| FaxNumber: | 5152822332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2020 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-11856 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.