Basic Information
| Provider Information | |||||||||
| NPI: | 1982064846 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAKISH SCHMIDT AND PARTNERS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONVENIENT CARE FAMILY MEDICINE AND WALK-IN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3502 METRO DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515017761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122567172 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3502 METRO DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515017761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122567172 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2016 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | KAKISH | ||||||||
| AuthorizedOfficialFirstName: | EYAD | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4025986995 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34436 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.