Ellerbroek, Kent P
Ellerbroek, Kent P is an sole proprietor health care provider with primary practice located at 541 King Dr , Waterloo IA 50702-5959. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Ellerbroek, Kent P can be contacted via phone (319) 235-6323.Contact Information
Primary practice address
541 King Dr
Waterloo IA 50702-5959
Phone: (319) 235-6323
Fax: (319) 235-0249
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 20213 | Iowa |
Profile Details
| NPI number | 1104800192 |
|---|---|
| LBN Legal business name | Ellerbroek, Kent P |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 2nd, 2005 |
| Last updated | Oct 14th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104800192 | NPPES |
| Iowa | MEDICAID | 0169805 |
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