Provider Demographics
NPI:1871586594
Name:VANDER PLOEG, KURT RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:RONALD
Last Name:VANDER PLOEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1538
Mailing Address - Country:US
Mailing Address - Phone:641-628-2222
Mailing Address - Fax:641-628-2915
Practice Address - Street 1:615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1538
Practice Address - Country:US
Practice Address - Phone:641-628-2222
Practice Address - Fax:641-628-2915
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2023-03-07
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
IA20762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13768OtherWELLMARK BLUE CROSS & BLU
IA16D0383065OtherCLIA NUMBER
IA0137687Medicaid
IAIA0101OtherJOHN DEERE HEALTHCARE
IAIA0101OtherJOHN DEERE HEALTHCARE
IA16D0383065OtherCLIA NUMBER
IA13768Medicare ID - Type Unspecified