Doctor Name: | DR. BENJAMIN VANRAALTE |
NPI Number: | 1528048451 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 29526 |
Business Practice Address: | 4334 E 53rd St Davenport, IA - 528073039 |
Business Phone Number: | 5633228877 |
Business Fax Number: | 5633228375 |
Mailing Address: | 2031 S 32nd St, LACROSSE |
State: | WI |
Postal Code: | 54601 |
Phone Number: | 5633228877 |
Fax Number: | 5633228375 |
NPI Enumeration Date: | 01/18/2006 |
NPI Last Update Date: | 05/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 29526 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |